title: Detection of neonatal unit clusters of Candida parapsilosis fungaemia by microsatellite genotyping: Results from laboratory-based sentinel surveillance, South Africa, 2009-2010.
abstract: Neonatal candidaemia is a common, deadly and costly hospital-associated disease. To determine the genetic diversity of Candida parapsilosis causing fungaemia in South African neonatal intensive care units (NICUs). From February 2009 through to August 2010, cases of candidaemia were reported through laboratory-based surveillance. C. parapsilosis isolates from neonatal cases were submitted for identification by internal transcribed spacer (ITS) region sequencing, antifungal susceptibility testing and microsatellite genotyping. Cluster analysis was performed using Unweighted Pair Group Method with Arithmetic Mean (UPGMA). Of 1671 cases with a viable Candida isolate, 393 (24%) occurred among neonates. Isolates from 143 neonatal cases were confirmed as C. parapsilosis sensu stricto. Many isolates were resistant to fluconazole (77/143; 54%) and voriconazole (20/143; 14%). Of 79 closely-related genotypes, 18 were represented by ≥2 isolates; 61 genotypes had a single isolate each. Seven clusters, comprised of 82 isolates, were identified at five hospitals in three provinces. Isolates belonging to certain clusters were significantly more likely to be fluconazole resistant: all cluster 7 isolates and the majority of cluster 4 (78%), 5 (89%) and 6 (67%) isolates (P<.001). Candida parapsilosis-associated candidaemia in public-sector NICUs was caused by closely related genotypes and there was molecular evidence of undetected outbreaks as well as intra-hospital transmission.
authors.affiliation: Division of the National Health Laboratory Service, National Institute for Communicable Diseases - Centre for Opportunistic, Tropical and Hospital Infections, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rindidzani E
authors.identifier: http://orcid.org/0000-0002-0950-0146
authors.initials: RE
authors.lastname: Magobo
authors.affiliation: Division of the National Health Laboratory Service, National Institute for Communicable Diseases - Centre for Opportunistic, Tropical and Hospital Infections, Johannesburg, South Africa.
authors.forename: Serisha D
authors.initials: SD
authors.lastname: Naicker
authors.affiliation: Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|National Health Laboratory Service, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Wadula
authors.affiliation: National Health Laboratory Service, Dr George Mukhari Hospital, Medical University of South Africa, Ga-Rankuwa, South Africa.
authors.forename: Maphoshane
authors.initials: M
authors.lastname: Nchabeleng
authors.affiliation: National Health Laboratory Service, Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Yacoob
authors.initials: Y
authors.lastname: Coovadia
authors.affiliation: National Health Laboratory Service, Universitas Hospital, University of the Free State, Bloemfontein, South Africa.
authors.forename: Anwar
authors.initials: A
authors.lastname: Hoosen
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Lockhart
authors.affiliation: Division of the National Health Laboratory Service, National Institute for Communicable Diseases - Centre for Opportunistic, Tropical and Hospital Infections, Johannesburg, South Africa.|Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Nelesh P
authors.initials: NP
authors.lastname: Govender
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology; D002175:Candida / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D058387:Candidemia / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D016000:Cluster Analysis; D021903:DNA, Ribosomal Spacer / Q000235:genetics; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D014644:Genetic Variation; D005838:Genotype; D060005:Genotyping Techniques; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008826:Microbial Sensitivity Tests; D018895:Microsatellite Repeats; D016533:Mycological Typing Techniques; D010802:Phylogeny; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology; D065819:Voriconazole / Q000494:pharmacology
chemical_list: D000935:Antifungal Agents; D021903:DNA, Ribosomal Spacer; D015725:Fluconazole; D065819:Voriconazole
keywords: 
  Candida parapsilosis
  ; South Africa; candidaemia; neonates