title: Outbreak of Candida tropicalis fungemia in a neonatal intensive care unit.
abstract: 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.
  
  
  METHODS
  Descriptive and case-control study.
  
  
  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.
authors.affiliation: Department of Internal Medicine, Rambam Medical Center, Israel Institute of Technology, Haifa.
authors.forename: R
authors.initials: R
authors.lastname: Finkelstein
authors.forename: G
authors.initials: G
authors.lastname: Reinhertz
authors.forename: N
authors.initials: N
authors.lastname: Hashman
authors.forename: D
authors.initials: D
authors.lastname: Merzbach
mesh_terms: D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks / Q000517:prevention & control; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D007557:Israel / Q000453:epidemiology; D012307:Risk Factors