title: Investigation of an unrecognized large-scale outbreak of Candida parapsilosis sensu stricto fungaemia in a tertiary-care hospital in China.
abstract: A data analysis of yeast collections from the National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) programme in 2013 revealed a sudden increase in the proportion of Candida parapsilosis complex isolates (n = 98) in one participating hospital (Hospital H). Out of 443 yeast isolates submitted to the CHIF-NET reference laboratory by Hospital H (2010-2014), 212 (47.9%) were identified as C. parapsilosis sensu stricto by sequencing analysis of the internal transcribed spacer region and D1/D2 domain of the 26S rRNA gene. Among the 212 C. parapsilosis sensu stricto isolates, 176 (83.0%) bloodstream-based isolates and 25 isolates from tip cultures of various vascular catheters from 25 patients with candidaemia, were subjected to microsatellite genotyping, and a phylogenetic relationship analysis was performed for 152 isolates. Among the 152 isolates, 45 genotypes (T01 to T45) were identified, and two prevalent genotypes (63.8%) were found: T15 (n = 74, 48.7%) and T16 (n = 23, 15.1%). These two main clones were confined mainly to three different wards of the hospital, and they persisted for 16-25 months and 12-13 months, respectively. The lack of proper coordination between the clinical microbiology laboratory and infection control staff as part of public health control resulted in the failure to timely identify an outbreak, which led to the wide and long-term dissemination of C. parapsilosis sensu stricto in Hospital H.
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.|Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: He
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Charles Sturt University, Leeds Parade, Orange, New South Wales, Australia.|Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Darcy Road, Westmead, New South Wales, Australia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kudinha
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Darcy Road, Westmead, New South Wales, Australia.
authors.forename: Fanrong
authors.initials: F
authors.lastname: Kong
authors.affiliation: Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Ma
authors.affiliation: Department of Clinical Laboratory, the First Hospital of China Medical University, Shenyang, China.
authors.forename: Yun-Zhuo
authors.initials: YZ
authors.lastname: Chu
authors.affiliation: Laboratory of Clinical Microbiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Zi-Yong
authors.initials: ZY
authors.lastname: Sun
authors.affiliation: Department of Clinical Laboratory, Peking University First Hospital, Beijing, China.
authors.forename: Ruo-Yu
authors.initials: RY
authors.lastname: Li
authors.affiliation: Department of Clinical Laboratory, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Kang
authors.initials: K
authors.lastname: Liao
authors.affiliation: Department of Clinical Laboratory, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Clinical Laboratory, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Gui-Ling
authors.initials: GL
authors.lastname: Zou
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Xiao
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.|Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology; D000074429:Candida parapsilosis / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D016533:Mycological Typing Techniques; D010802:Phylogeny; D062606:Tertiary Care Centers; D065819:Voriconazole / Q000494:pharmacology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D065819:Voriconazole