title: Pichia anomala outbreak in a nursery: exogenous source?
abstract: BACKGROUND
  Pichia anomala is a rare cause of fungemia. From February to April, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infection, one of whom also had Candida parapsilosis infection, two cases with C. parapsilosis infection and two with Candida albicans infection.
  
  
  OBJECTIVE
  To determine factors associated with fungemia in the intensive care and high risk units of the Nursery, especially P. anomala.
  
  
  METHODS
  A cohort study with 59 newborns.
  
  
  RESULTS
  Factors associated with fungemia were: central venous catheter (CVC) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emulsion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN formulation and education as to adequate technique were implemented. During follow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Electrophoretic karyotyping of P. anomala showed three profiles.
  
  
  CONCLUSIONS
  Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.
authors.affiliation: Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: P A
authors.initials: PA
authors.lastname: Aragão
authors.forename: I C
authors.initials: IC
authors.lastname: Oshiro
authors.forename: E I
authors.initials: EI
authors.lastname: Manrique
authors.forename: C C
authors.initials: CC
authors.lastname: Gomes
authors.forename: L L
authors.initials: LL
authors.lastname: Matsuo
authors.forename: C
authors.initials: C
authors.lastname: Leone
authors.forename: M L
authors.initials: ML
authors.lastname: Moretti-Branchini
authors.forename: A S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000704:Analysis of Variance; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D010843:Pichia / Q000302:isolation & purification*; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects