Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India.
Mycopathologia. 2020 Apr;185(2):257-268. doi: 10.1007/s11046-020-00427-y. Epub 2020 Jan 25.
A sudden rise of Candida krusei candidemia cases was noticed in our hospital within 1 year with maximum cases from paediatric unit. The present study reports the results of epidemiological investigation of possible outbreak of candidemia by C. krusei in paediatric unit at our tertiary care centre.
Clinical characteristics and risk factors associated with C. krusei candidemia were evaluated. Yeast identification and antifungal susceptibility testing was performed according to standard protocol. To find the potential source of C. krusei in hospital environment and hand colonization, swabs were collected from different fomites (n = 40) and hand washings from 24 health care workers (HCW), respectively. Infection control and prevention practices were intensified following the recognition of outbreak. Genetic typing was done by fluorescent amplified fragment length polymorphism (FAFLP) technique. Case-control comparison was performed with C. tropicalis and C. pelliculosa cases.
Candida krusei fungaemia significantly affected paediatric group (82/186, 44%) as compared to adults (14/130, 10.8%; p < 0.001). Among paediatric group, maximum isolation was reported from neonatal unit of paediatric emergency (NUPE). C. krusei was isolated from hands of one HCW and washbasin in NUPE. FAFLP revealed clonality between blood and environmental isolates indicating cross-transmission of C. krusei. Gastrointestinal disease (p = 0.018), previous antibiotics (p = 0.021) especially to carbapenems (p = 0.039), was significant among C. krusei candidemia cases compared to C. pelliculosa cases.
We report the largest outbreak of C. krusei candidemia in paediatric unit within 1 year with isolation of related strains from environment and hands of HCW. Routine screening of hand hygiene practices revealed non-compliance to standard practices leading to the increase in C. krusei candidemia cases.
在过去的 1 年内，我院突然出现大量克柔念珠菌血症病例，且大多数病例来自儿科病房。本研究报告了我们的三级护理中心儿科病房克柔念珠菌血症爆发的流行病学调查结果。
评估了与克柔念珠菌血症相关的临床特征和危险因素。根据标准方案进行酵母鉴定和抗真菌药敏试验。为了寻找医院环境和手部定植中的克柔念珠菌潜在来源，分别从不同的污染物（n=40）和 24 名医护人员（HCW）的手部洗涤物中采集拭子。在识别爆发后，加强了感染控制和预防措施。使用荧光扩增片段长度多态性（FAFLP）技术进行基因分型。与热带念珠菌和光滑念珠菌病例进行病例对照比较。
克柔念珠菌血症显著影响儿科组（82/186，44%），而非成人组（14/130，10.8%；p<0.001）。在儿科组中，新生儿急救儿科病房（NUPE）的分离率最高。在一名 HCW 的手部和 NUPE 的洗面盆中分离到克柔念珠菌。FAFLP 显示血液和环境分离株之间存在克隆性，表明克柔念珠菌的交叉传播。与光滑念珠菌病例相比，胃肠道疾病（p=0.018）、先前使用抗生素（p=0.021）尤其是碳青霉烯类（p=0.039）在克柔念珠菌血症病例中更为显著。
我们报告了过去 1 年内儿科病房中克柔念珠菌血症的最大爆发，从环境和 HCW 手部分离到相关菌株。常规筛查手部卫生实践发现不符合标准实践，导致克柔念珠菌血症病例增加。
