Outbreak of Mixed fungemia in a Children’s Hospital in the United States
Methods: From June 2013 to January 2014, 5 patients with C. pelliculosa fungemia were identified in our hospital, the first 3 of whom had a mixed fungemia with C. parapsilosis. To confirm the outbreak, the C. parapsilosis isolates underwent molecular typing using a panel of 5 multilocus microsatellite markers. The C. parapsilosis isolates were genotyped using a published microsatellite type protocol. The C. pelliculosa isolates were genotyped using newly developed multilocus sequence typing of 5 different genes. Chart reviews were done on all patients admitted to the relevant unit within 6 days of each case’s infection date. The proportions of select medications during the same time period were compared between the 5 cases and the remaining patient pool.
Results: Four cases occurred within 56 day period. The fifth case occurred 203 days after the fourth case. Two cases died. All 5 cases were admitted in the intensive care unit (ICU) (1 in the neonatal ICU and 4 in the pediatric ICU). Three cases were male and the median age was 293 days (range 10-369 days). Total Parenteral Nutrition (TPN) use was significantly higher in cases (5/5; 100%) when compared with controls (52/164; 31.7%); this difference was statistically significant (p=.004). The results of the genotyping data for the 3 C. parapsilosis isolates and the 5 C. pelliculosa isolates showed that the isolates from the patients were identical to one another and different from unrelated control isolates, suggesting a clonal origin.
Conclusion: The genotyping analysis of the C. parapsilosis and C. pelliculosa isolates confirmed identity of the strains and suggested an outbreak. TPN use was a risk factor and a possible source of infection. Environmental cultures may aid in identification of the point source. To our knowledge, this is the first reported outbreak of C. pelliculosa fungemia in children from the United States.
S. Lockhart, None
C. Pham, None
N. Grossman, None
R. Selvarangan, None
R. A. Livingston, None