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Candida parapsilosis bloodstream infections in neonatal intensive care unit patients: epidemiologic and laboratory
S F Welbel1, M M McNeil, R J Kuykendall
1Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Background:
Candida parapsilosis is a common cause of sporadic and epidemic infections in neonatal intensive care units (NICUs). When a cluster of C. parapsilosis bloodstream infections occurred in NICU patients in a hospital in Louisiana, it provided us with the opportunity to conduct an epidemiologic investigation and to apply newly developed molecular typing techniques.
Methods:
A case-patient was defined as any NICU patient at Louisiana State University Medical Center, University Hospital, with a blood culture positive for C. parapsilosis during July 20 to 27, 1991. To identify risk factors for C. parapsilosis bloodstream infection, a cohort study of all NICU infants admitted during July 17 to 27, 1991, was performed. Electrophoretic karyotyping was used to assess the relatedness of C. parapsilosis isolates.
Results:
The receipt of liquid glycerin given as a suppository was identified as a risk factor (relative risk, 31.2; 95% confidence intervals, 4.3 to 226.8). Glycerin was supplied to the NICU in a 16-oz multidose bottle. Bottles used at the time of the outbreak were not available for culture. All six available isolates from four case-patients had identical chromosomal banding patterns; six University Hospital non-outbreak isolates had different banding patterns.
Conclusions:
This study demonstrates the utility of combined epidemiologic and laboratory techniques in identifying a novel common source for a C. parapsilosis bloodstream infection outbreak and illustrates that extreme caution should be exercised when using multidose medications in more than one patient.
Insights
A cluster of Candida parapsilosis bloodstream infections in a NICU was linked to glycerin suppositories. This highlights the risk of multidose medications in healthcare settings.
Area of Science:
- Infectious Diseases
- Epidemiology
- Medical Microbiology
Background:
- Candida parapsilosis frequently causes infections in neonatal intensive care units (NICUs).
- An outbreak of C. parapsilosis bloodstream infections occurred in NICU patients in Louisiana.
Purpose of the Study:
- To investigate an outbreak of C. parapsilosis bloodstream infections in a NICU.
- To identify risk factors and the common source of the outbreak.
- To apply molecular typing techniques to C. parapsilosis isolates.
Main Methods:
- A case-patient definition was established for NICU infants with positive blood cultures for C. parapsilosis.
- A cohort study was conducted to identify risk factors among NICU infants.
- Electrophoretic karyotyping was used to analyze the genetic relatedness of C. parapsilosis isolates.
Main Results:
- Receipt of liquid glycerin as a suppository was identified as a significant risk factor (RR, 31.2).
- The glycerin was supplied in multidose bottles.
- Identical chromosomal banding patterns were observed in isolates from case-patients, distinct from non-outbreak isolates.
Conclusions:
- Combined epidemiologic and laboratory methods successfully identified a novel common source for the C. parapsilosis outbreak.
- The study underscores the importance of caution when using multidose medications across multiple patients.