Epidemiologic and Molecular Characterization of an Outbreak of Candida parapsilosis Bloodstream Infections in a Community Hospital

Abstract

Candida parapsilosis is an important cause of bloodstream infections in the health care setting. We investigated a large C. parapsilosis outbreak occurring in a community hospital and conducted a case-control study to determine the risk factors for infection. We identified 22 cases of bloodstream infection with C. parapsilosis: 15 confirmed and 7 possible. The factors associated with an increased risk of infection included hospitalization in the intensive care unit (adjusted odds ratio, 16.4; 95% confidence interval, 1.8 to 148.1) and receipt of total parenteral nutrition (adjusted odds ratio, 9.2; 95% confidence interval, 0.9 to 98.1). Samples for surveillance cultures were obtained from health care worker hands, central venous catheter insertion sites, and medical devices. Twenty-six percent of the health care workers surveyed demonstrated hand colonization with C. parapsilosis, and one hand isolate was highly related to all case-patient isolates by tests with the DNA probe Cp3-13. Outbreak strain isolates also demonstrated reduced susceptibilities to fluconazole and voriconazole. This largest known reported outbreak of C. parapsilosis bloodstream infections in adults resulted from an interplay of host, environment, and pathogen factors. Recommendations for control measures focused on improving hand hygiene compliance.

Prevalence of fungemia in a tertiary hospital: Analysis of the last decade

“…C. parapsilosis has been linked to vascular catheter and parenteral nutrition. 24,25 C. tropicalis was associated with cancer and neutropenia. 26,27 C. krusei has been associated with prior use of azoles, neutropenia and hematologic malignancies.…”

Candida isolates in tertiary hospitals in northeastern Brazil

“…The yeast is capable of forming biofilm in gucosilated solutions and adhering to plastic materials, such as catheters used for parenteral nutrition. Over the last few years, outbreaks and clusters of cross-transmission, total parenteral nutrition solutions, intravascular devices, and medications have been related to C. parapsilosis fungemia (5,10,21). In addition, C. parapsilosis is an important pathogen of onychomycosis in fingernails (3,11).…”

An outbreak of Candida parapsilosis fungemia among preterm infants

“…The prevalence of C. parapsilosis fungemia has increased over the years, and now, in some areas, it is the second most common species found in candidemia patients (Clark et al, 2004). The reasons for the rising incidence of C. parapsilosis candidemia are not completely known.…”