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Outbreak of Candida tropicalis fungemia in a neonatal intensive care unit
R Finkelstein1, G Reinhertz, N Hashman
1Department of Internal Medicine, Rambam Medical Center, Israel Institute of Technology, Haifa.
Objective:
To describe an outbreak of Candida tropicalis fungemia in a neonatal intensive care unit (NICU), to evaluate the risk factors associated with this infection and the possible mode of nosocomial transmission.
Design:
Descriptive and case-control study.
Patients And Methods:
Surveillance cultures were taken from hospitalized patients, personnel, and inanimate objects in the NICU. Six patients with C tropicalis fungemia (cases) were compared with C tropicalis culture-negative patients matched for duration of exposure to the NICU (controls).
Results:
During a five-month period, C tropicalis was isolated from 29 blood cultures of six premature infants. The same organism also was isolated from fingernail samples taken from the ward housekeeper, who had a mild onychomycosis, and an asymptomatic nurse. Other potential reservoirs of C tropicalis were not identified among all the other infants or in the hospital environment. The six patients with C tropicalis fungemia were more likely to have received a larger number of antibiotics (4.0 versus 1.8, P < 0.001) and to have been subjected to a longer duration of total parenteral nutrition (TPN) therapy (8.5 versus 2.67 days, P = 0.004) than the controls.
Conclusions:
The risk of fungemia in this outbreak can be attributed to a larger number of antibiotics and a longer period of TPN administered to the patients. Analysis of events suggests that the outbreak may have been the result of cross-infection between staff and patients.
Insights
An outbreak of Candida tropicalis fungemia in a neonatal intensive care unit (NICU) was linked to increased antibiotic use and prolonged total parenteral nutrition (TPN). Cross-infection between staff and patients is suspected.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Neonatology
Background:
- Neonatal intensive care units (NICUs) are susceptible to hospital-acquired infections.
- Candida tropicalis is an opportunistic fungal pathogen that can cause serious infections in vulnerable neonates.
Purpose of the Study:
- To investigate an outbreak of Candida tropicalis fungemia in an NICU.
- To identify risk factors and potential transmission routes of the infection.
Main Methods:
- A descriptive and case-control study design was employed.
- Surveillance cultures were collected from patients, staff, and the NICU environment.
- Cases (infants with C. tropicalis fungemia) were compared to controls (culture-negative infants).
Main Results:
- Six premature infants developed C. tropicalis fungemia over five months.
- The organism was isolated from a housekeeper and a nurse, suggesting potential human reservoirs.
- Patients with fungemia received more antibiotics and longer total parenteral nutrition (TPN) compared to controls.
Conclusions:
- Increased antibiotic exposure and prolonged TPN were identified as risk factors for fungemia.
- Cross-infection between healthcare staff and neonates is the likely mode of transmission for this C. tropicalis outbreak.