Nagarathnamma T, Chunchanur Sneha K, Rudramurthy Shivaprakash M, Vineetha K R, Ramamurthy Karthik, Joseph Jillwin, Ambica R
Department of Microbiology, Bangalore Medical College and Research Institute, Bangalore, India.
Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Med Microbiol. 2017 Dec;66(12):1759-1764. doi: 10.1099/jmm.0.000645. Epub 2017 Nov 14.
Fungaemia is associated with substantial morbidity and mortality in neonates admitted to neonatal intensive care units (NICUs). We report an outbreak of fungaemia in a NICU due to rare yeast, Pichia kudriavzevii (a teleomorph of Candida krusei). To the best of our knowledge, this is the first report of neonatal sepsis due to P. kudriavzevii.
Between August and September 2014, blood cultures from nine neonates diagnosed with late-onset sepsis in the NICU yielded yeast-like organisms. The molecular identification and typing of these isolates was performed by sequencing the D1/D2 region of 26S rDNA and fluorescent amplified fragment length polymorphism (FAFLP) respectively. Antifungal susceptibility was tested by broth microdilution as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Sampling from environmental sources and the hands of healthcare workers (HCWs) in the NICU was performed.
Of the nine neonates, eight were preterm and six had very low birth weight (VLBW). Thrombocytopenia was present in two neonates. Sequencing identified all the isolates as P. kudriavzevii and FAFLP showed their clonal origin. Antifungal susceptibility testing revealed the susceptibility of all isolates to the antifungals tested. Treatment with voriconazole was advised. However, only seven neonates were treated successfully and discharged after improvement, whereas two were lost for follow-up. Cultures from the environment and the hands of HCWs were negative. The outbreak was controlled by the strict implementation of infection control practices.
This study emphasizes the importance of accurate identification of the aetiological agent of sepsis and vigilant monitoring for the possibility of an outbreak in NICUs.
真菌血症与入住新生儿重症监护病房（NICU）的新生儿的高发病率和死亡率相关。我们报告了一家NICU因罕见酵母库德里阿兹毕赤酵母（克鲁斯假丝酵母的有性型）爆发真菌血症。据我们所知，这是首例关于库德里阿兹毕赤酵母所致新生儿败血症的报告。
2014年8月至9月期间，对NICU中9例被诊断为晚发性败血症的新生儿的血培养物进行检测，分离出酵母样微生物。分别通过对26S rDNA的D1/D2区域进行测序和荧光扩增片段长度多态性分析（FAFLP）对这些分离株进行分子鉴定和分型。根据临床实验室标准协会（CLSI）指南，采用肉汤微量稀释法检测抗真菌药敏性。对NICU的环境来源和医护人员的手部进行了采样。
9例新生儿中，8例为早产儿，6例出生体重极低（VLBW）。2例新生儿出现血小板减少。测序鉴定所有分离株均为库德里阿兹毕赤酵母，FAFLP显示它们具有克隆起源。抗真菌药敏试验显示所有分离株对所检测的抗真菌药物敏感。建议使用伏立康唑进行治疗。然而，只有7例新生儿治疗成功并在病情改善后出院，2例失访。环境和医护人员手部的培养结果均为阴性。通过严格实施感染控制措施，疫情得到了控制。
本研究强调了准确鉴定败血症病原体以及对NICU爆发疫情可能性进行密切监测的重要性。
