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Outbreak of Candida albicans fungaemia in a neonatal intensive care unit
1Division of Infectious Diseases, Chang Gung Childrens Hospital, Taoyuan, Taiwan, ROC.
Abstract:
During a 4-month period, 9 premature infants hospitalized in a neonatal intensive care unit (NICU) developed Candida albicans fungaemia. All 9 infants received antifungal agents. Fluconazole was administered in 7 patients and successfully eradicated this organism in 6 with no adverse effects. For epidemiological investigation, 64 environmental specimens and hand-washings of all 54 staff members involved in the NICU were examined for the presence of this organism. No C. albicans could be identified from environmental sources, while the hand-washing of 1 nurse was C. albicans-positive. Two genotyping methods, including electrophoretic karyotyping using contour-clamped homogeneous electric field gel electrophoresis and polymerase chain reaction-based direct sequencing of rRNA gene, were used in the analysis of the isolates recovered from blood cultures of the infants, the hand-washing of the nurse and 7 control isolates. Both methods yielded comparable results and revealed that all 13 isolates from infected infants as well as the isolate from hand washing of the nurse were of the same genotype while the control isolates were distinct. These results suggest that the outbreak of C. albicans fungaemia was caused by a particular strain and possibly via cross-infection. In addition, we showed that fluconazole seemed to be safe and effective in treating C. albicans fungaemia in neonates, although the data were limited.
Insights
A Candida albicans outbreak in a neonatal intensive care unit (NICU) was likely spread by a single strain via cross-infection. Fluconazole proved safe and effective for treating infant Candida albicans fungaemia.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Medical Mycology
Background:
- Candida albicans fungaemia poses a significant risk to premature infants in neonatal intensive care units (NICUs).
- Understanding the transmission routes and effective treatment strategies is crucial for managing these infections.
Purpose of the Study:
- To investigate an outbreak of Candida albicans fungaemia in a NICU.
- To identify the source and transmission dynamics of the infection.
- To evaluate the efficacy and safety of fluconazole in treating neonatal candidemia.
Main Methods:
- Epidemiological investigation including environmental sampling and staff hand-washing surveillance.
- Genotyping of Candida albicans isolates using contour-clamped homogeneous electric field gel electrophoresis (CHEF) and rRNA gene sequencing.
- Clinical data review for antifungal treatment outcomes.
Main Results:
- Nine premature infants developed Candida albicans fungaemia.
- Genotyping confirmed a single strain responsible for infant infections and identified a nurse's hand-washing as a potential source.
- Fluconazole eradicated Candida albicans in 6 out of 7 treated infants with no adverse effects.
Conclusions:
- The outbreak was likely caused by a specific strain of Candida albicans, possibly transmitted through cross-infection.
- Fluconazole demonstrated safety and efficacy in treating Candida albicans fungaemia in neonates.
- Further research with larger cohorts is warranted to confirm fluconazole's effectiveness.