Reporting an outbreak of Candida pelliculosa fungemia in a neonatal intensive care unit.
BACKGROUND
Fungemia in preterm infants is associated with high mortality and morbidity. This study reports an outbreak of unusual fungemia in a tertiary neonatal intensive care unit (NICU).


METHODS
Ten Candida pelliculosa bloodstream isolates were identified from six infants hospitalized in the NICU from February to March 2009. Environmental study was performed, and genetic relatedness among the 10 clinical isolates of C pelliculosa and six control C pelliculosa strains was characterized by randomly amplified polymorphic DNA assay. In vitro susceptibility of isolates to six antifungal agents was analyzed by broth microdilution method. Amphotericin B was given to infected infants and prophylactic fluconazole was prescribed to the other noninfected extremely low birth weight infants during the outbreak.


RESULTS
Thrombocytopenia (platelet counts <100×10(9)/L) was the early laboratory finding in four infants. One of six patients died, making overall mortality 17%. Fluconazole, voriconazole, amphotericin B, and micafungin provided good antifungal activity. Cultures from the environment and hands of caregivers were all negative. Molecular studies indicated the outbreak as caused by a single strain. The outbreak was controlled by strict hand washing, cohort infected patients, confined physicians and nurses to take care of patients, prophylactic fluconazole to uninfected neonates, and proper management of human milk.


CONCLUSIONS
The study demonstrated the clinical importance of emerged non-albicans Candida species in NICU. For unusual pathogen isolated from immunocompromised hosts, more attention should be paid to monitor the possibility of an outbreak.
Department of Public Health, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Hsiao-Chuan
HC
Lin
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Hsiang-Yu
HY
Lin
School of Medicine, China Medical University, Taichung, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Bai-Hong
BH
Su
Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Mao-Wang
MW
Ho
Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan.
Cheng-Mao
CM
Ho
Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan.
Ching-Yi
CY
Lee
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Ming-Hsia
MH
Lin
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Hsin-Yang
HY
Hsieh
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Hung-Chih
HC
Lin
Institute of Health Care Administration, College of Public Health, China Medical University and Hospital, Taichung, Taiwan; Graduate Institute of Biostatistics and Chinese Medicine Science, China Medical University and Hospital, Taichung, Taiwan; Biostatistics Center, China Medical University and Hospital, Taichung, Taiwan.
Tsai-Chung
TC
Li
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Kao-Pin
KP
Hwang
Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan. Electronic address: janglu45@gmail.com.
Jang-Jih
JJ
Lu
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D007363:Intensive Care Units, Neonatal; D008297:Male; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D019105:Random Amplified Polymorphic DNA Technique; D016896:Treatment Outcome
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole