title: Candida albicans outbreak associated with total parenteral nutrition in the neonatal unit.
abstract: BACKGROUND
  The most frequently isolated fungi in patients using TPN belongs to the Candida genus. Various infections including venous catheter infections, fungemia, endocarditis and ophthalmitis may be encountered.
  
  
  OBJECTIVE
  Upon growth of Candida in the blood cultures from the pediatric (neonatal) unit of our hospital, a surveillance was performed in this unit and involving the health care workers. Clonal relationships of the isolates were investigated with molecular tests.
  
  
  METHODS
  Blood samples obtained from the patients in pediatric neonatal unit were studied with automatized blood culture [BacT/Alert (Bio Mιrioux, France)]. Yeast isolates from environmental surveillance cultures (TPN solutions, hands of healthcare personnel, ιtagθre, etc) and patients were identified as C. albicans with conventional methods and ID 32 C and ATB TM Fungus 3 (Biomerieux, France) kits. Clonal similarity was determined by using AP-PCR as initial method and we have also typified all strains by the method of REP-PCR (diversilab system,bioMιrieux). Finally; Pulsed Field Gel Electrophoresis (PFGE) was used for confirmation.
  
  
  RESULTS
  C. albicans was isolated in blood cultures of seven patients. Similar antifungal susceptibility patterns were observed in all isolates. AP-PCR and REP-PCR showed that the C. albicans isolates grown in the TPN solution and from the patients' blood cultures were clonally same strains. PFGE analysis further confirmed this clonality.
  
  
  CONCLUSIONS
  According to results of the molecular methods, we thought that a C. albicans outbreak had occurred in the neonatal pediatric unit, due to contamination of TPN solution.
authors.affiliation: Department of Medical Microbiology, School of Medicine, Yuzuncu Yil University, Van, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Guducuoglu
authors.forename: B
authors.initials: B
authors.lastname: Gultepe
authors.forename: B
authors.initials: B
authors.lastname: Otlu
authors.forename: A
authors.initials: A
authors.lastname: Bektas
authors.forename: O
authors.initials: O
authors.lastname: Yildirim
authors.forename: O
authors.initials: O
authors.lastname: Tuncer
authors.forename: M
authors.initials: M
authors.lastname: Berktas
mesh_terms: D001769:Blood / Q000382:microbiology; D002176:Candida albicans / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D017720:Molecular Epidemiology; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D010289:Parenteral Nutrition, Total / Q000009:adverse effects*