Neonatal Candida parapsilosis outbreak with a high case fatality rate

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Medical Microbiology

Background:

• Candida parapsilosis outbreaks pose significant risks in neonatal intensive care units (NICUs).
• Very low birth weight infants are particularly vulnerable to invasive fungal infections.
• Understanding risk factors and effective interventions is crucial for managing NICU outbreaks.

Purpose of the Study:

• To investigate the epidemiology and risk factors of a prolonged Candida parapsilosis outbreak in a NICU.
• To assess the impact of C. parapsilosis infection on infant outcomes.
• To identify factors contributing to the outbreak's cessation.

Main Methods:

• Retrospective analysis of 58 cases of C. parapsilosis infection/colonization over 55 months.
• Statistical analysis, including logistic regression, to identify risk factors.
• Evaluation of patient outcomes and intervention effectiveness.

Main Results:

• The outbreak primarily affected very low birth weight infants (mean birth weight 817g, mean gestational age 28 weeks).
• Prematurity (<29 weeks gestational age) was the main risk factor, with a 16-fold increased risk of death in infected infants.
• A higher case fatality rate was observed in infected infants compared to controls (9/23 vs 1/40).
• Cross-infection via healthcare worker hands was the likely transmission route.
• Long-term parenteral fluconazole prophylaxis was temporally associated with outbreak cessation.

Conclusions:

• Prematurity is a critical risk factor for C. parapsilosis infection in NICU outbreaks.
• C. parapsilosis infection is associated with poor prognosis and increased mortality in extremely premature infants.
• Effective infection control measures and antifungal prophylaxis, such as fluconazole, are essential for managing and resolving NICU outbreaks.