Outbreak ofCandida parapsilosis fungemia in neonatal intensive care units: Clinical implications and genotyping analysis
Tóm tắt
During a 5-month period, 17 infants hospitalized in neonatal intensive care units of a medical center and a branch hospital developed 18 episodes ofCandida parapsilosis fungemia. The mean age at onset was 35 days. Prior to fungemia, all the infants had received hyperalimentation and antibiotics, and 15 infants had had central venous catheters. The presenting symptoms were variable but only vague in 40% of the episodes. Despite administration of antifungal agents, subsequent eradication of fungemia was achieved in only two-thirds of the episodes. None of the environmental samples was positive forC. parapsilosis, while 20% of hand-washing samples of staff working in both units yielded this microorganism. Four genotypes with two main types were identified from 14 outbreak strains and eight genotypes from 14 hand-washing strains, with one type predominant. The results suggest thatC. parapsilosis fungemia increases the morbidity and mortality of neonates but does not cause acute lethal events. The outbreak was caused by two main genotypes, possibly via cross-infection by the hands of health care workers.
Tài liệu tham khảo
Butler, K. M., Baker, C. J.:Candida: an increasingly important pathogen in the nursery. Pediatr. Clin. North Am. 35 (1988) 543–563.
Baley, J. E.: Neonatal candidiasis: the current challenge. Clin. Perinatol. 18 (1991) 263–280.
Ng, P. C.: Systemic fungal infections in neonates. Arch. Dis. Child. 71 (1994) F130–135.
Baley, J. E., Kliegman, R. M., Fanaroff, A. A.: Disseminated fungal infections in very low-birth-weight infants: clinical manifestations and epidemiology. Pediatrics 73 (1984) 144–152.
Rowen, J. L., Rench, M. A., Kozinatz, C. A., Adams, J. M., Baker, C. J.: Endotracheal colonization withCandida enhances risk of systemic candidiasis in very low birth weight neonates. J. Pediatr. 124 (1994) 789–794.
Johnson, D. E., Thompson, T. R., Green, T. P., Ferrieri, P.: Systemic candidiasis in very-low-birth-weight infants (<1,500 grams). Pediatrics 73 (1984) 138–143.
Weese-Mayer, D. E., Fondriest D. W., Brouillette, R. T., Shulman, S. T.: Risk factors associated with candidemia in the neonatal intensive care unit: a case-control study. Pediatr. Infect. Dis. J. 6 (1987) 190–196.
Saxen, H., Virtanen, M., Carlson, P., Hoppu, K., Pohjavuori, M., Vaara, M., Vuopio-Varkila, J., Peltola, H.: NeonatalCandida parap-silosis outbreak with a high case fatality rate. Pediatr. Infect. Dis. J. 14 (1995) 776–781.
Betremieux, P., Chevrier, S., Quindos, G., Sullivan, D., Polonelli, L., Guiguen, C.: Use of DNA fingerprinting and biotyping methods to study aCandida albicans outbreak in a neonatal intensive care unit. Pediatr. Infect. Dis. J. 13 (1994) 899–905.
Burnie, J. P., Odds, F. C., Lee, W., Webster, C., Williams, J. D.: Outbreak of systemicCandida albicans in intensive care unit caused by cross infection. BMJ 290 (1985) 746–748.
Hunter, P. R., Harrison, G. A. J., Fraser, C. A. M.: Cross infection and diversity ofCandida albicans strains carriage in patients and nursing staff in an intensive care unit. J. Med. Vet. Mycol. 28 (1990) 317–325.
Plouffe, J. F., Brown, D. G., Silva, J Jr., Eck, T., Stricof, R. L., Fekety, R. Jr.: Nosocomial outbreak ofCandida parapsilosis fungemia related to intravenous infusions. Arch. Intern. Med. 137 (1977) 1686–1689.
Weem, J. J. Jr., Chamberland, M. E., Ward, J., Willy, M., Padhye, A. A., Solomon, S. L.:Candida parapsilosis fungemia associated with parenteral nutrition and contaminated blood pressure transducers. J. Clin. Microbiol. 25 (1987) 1029–1032.
McCray, E., Rampell, N., Solomon, S. L., Bond, W. W., Martone, W. H., O'Day, D.: Outbreak ofCandida parapsilosis endophthalmitis after cataract extraction and intraocular lens implantation. J. Clin. Microbiol. 24 (1986) 625–628.
Sheretz, R. J., Gledhill, K. S., Hampton, K. D., Pfaller, M. A., Givner, L. B., Abramson, J. S., Dillard, R. G.: Outbreak ofCandida blood-stream infections associated with retrograde medication administration in a neonatal intensive care unit. J. Pediatr. 120 (1992) 455–461.
National Committee for Clinical Laboratory Standards: Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard. NCCLS document M27-A. NCCLS, Pennsylvania, 1997.
White, T. J., Bruns, T., Lee, S., Taylor, J.: Amplification and direct sequencing of fungal ribosomal RNA genes for phylogenetics. In:Innis, M.A., Gelfand, D.H., Sninsky, J.J., White, T.J. (eds.) PCR protocols: a guide to methods and applications. Academic Press, San Diego, CA 1990, pp. 315–322.
Schwartz, D. C., Cantor, C. R.: Separation of yeast chromosome-sized DNAs by pulse field gradient gel electrophoresis. Cell 37 (1984) 67–75.
Stamos, J. K., Rowley, A. H.: Candidemia in a pediatric population. Clin. Infect. Dis. 20 (1995) 571–575.
Faix, R. G.: Invasive neonatal candidiasis: comparison ofalbicans andparapsilosis infection. Pediatr. Infect. Dis. J. 11 (1992) 88–93.
Weems, J. J. Jr.:Candida parapsilosis: epidemiology, pathogenicity, clinical manifestations, and antimicrobial susceptibility. Clin. Infect. Dis. 14 (1992) 756–766.
Ghannoum, M. A., Rex, J. H., Galgiani, J. N.: Susceptibility testing of fungi: current status of correlation ofin vitro data with clinical outcome. J. Clin. Microbiol. 34 (1996) 489–495.
Seidenfeld, S. M., Cooper, B. H., Smith, J. W., Luby, J. P., Mackowiak, P. A.: Amphotericin B tolerance: a characteristic ofCandida parapsilosis not shared by otherCandida species. J. Infect. Dis. 147 (1983) 116–119.
Strausbaugh, L. J., Swell, D. L., Ward, T. T., Pfaller, M. A., Heitzman, T., Tjoelker, P.: High frequency of yeast carriage on hands of hospital personnel. J. Clin. Microbiol. 32 (1994) 2299–2300.
Huang, Y.-C., Lin, T.-Y., Leu, H.-S., Wu, J.-L., Wu, J.-H.: Yeast carriage on hands of hospital personnel working in intensive care units. J. Hosp. Infect. 39 (1998) 47–51.
Levin, A. S., Costa, S. F., Mussi, N. S., Basso, M., Sinto, S. I., Machado, C., Geiger, D. C., Villares, M. C. B., Schreiber, A. Z., Barone, A. A., Branchini, M. L. M.:Candida parapsilosis fungemia associated with implantable and semi-implantable central venous catheters and the hands of healthcare workers. Diagn. Microbiol. Infect. Dis. 30 (1998) 243–249.