Pichia anomala outbreak in a nursery: exogenous source?

Aragao, Paula A.; Oshiro, Isabel Cristina Villela Soares; Manrique, Edison I.; Gomes, Cristiana C.; Matsuo, Lisa; Leone, Cléa Rodrigues; Moretti-Branchini, Maria Luiza; Levin, Anna S.

doi:10.1097/00006454-200109000-00004

Cited by 47 publications

(41 citation statements)

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“…C. pelliculosa (formerly Hansenula anomala; teleomorph, Pichia anomala) is a yeast found in plants, fruits, soil, and other organic matter. Human infections are generally sporadic, but outbreaks have been reported (4,7,13,37,67,69). C. pelliculosa has been recognized as an emerging opportunistic pathogen, mainly in immunocompromised patients and patients in neonatal intensive care units, resulting in serious nosocomial infections (4,7,13,37,67,69).…”

Section: Resultsmentioning

confidence: 99%

“…Human infections are generally sporadic, but outbreaks have been reported (4,7,13,37,67,69). C. pelliculosa has been recognized as an emerging opportunistic pathogen, mainly in immunocompromised patients and patients in neonatal intensive care units, resulting in serious nosocomial infections (4,7,13,37,67,69). The most extensive outbreak of C. pelliculosa fungemia occurred over a period of 23 months and involved a total of 379 neonates and children in a pediatric service unit in India (13).…”

Section: Resultsmentioning

confidence: 99%

“…Molecular epidemiologic studies suggested a common source. An additional seven outbreaks of C. pelliculosa (P. anomala) fungemia in either neonatal or pediatric intensive care units, affecting patients ranging in number from 2 to 24 (4,7,59,67,69,102,111), and two outbreaks involving adult patients (4 and 8 patients, respectively) (37, 54) have been reported in the literature. In several of these outbreaks, analyses of the epidemic curve and molecular epidemiologic markers suggested a common exogenous source for C. pelliculosa (P. anomala) fungemia.…”

Section: Resultsmentioning

confidence: 99%

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In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

et al. 2009

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2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were C. guilliermondii. All isolates of the less common species within the C. parapsilosis complex (C. orthopsilosis and C. metapsilosis) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare Candida species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g., C. rugosa and C. guilliermondii) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

et al. 2009

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“…Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.Several reports have pointed to Pichia anomala (anamorph Candida pelliculosa) as a cause of a large spectrum of invasive infections (13,20,23,35), fungemia being the most common presentation (2,6,17,26,41). Usually, the patients have been treated with amphotericin B (with or without 5-flucytosine) or fluconazole with good clinical outcomes (3,6,12,16,26,38).…”

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Antifungal Drug Susceptibility Profile of Pichia anomala Isolates from Patients Presenting with Nosocomial Fungemia

Matta

Melhem

Colombo

et al. 2007

Antimicrob Agents Chemother

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In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.Several reports have pointed to Pichia anomala (anamorph Candida pelliculosa) as a cause of a large spectrum of invasive infections (13,20,23,35), fungemia being the most common presentation (2,6,17,26,41). Usually, the patients have been treated with amphotericin B (with or without 5-flucytosine) or fluconazole with good clinical outcomes (3,6,12,16,26,38). Nonetheless, treatment failures may occur (1,6,43), as may cases of breakthrough fungemias in immunocompromised patients receiving prophylaxis with fluconazole (14).Although P. anomala is considered an emergent hematogenous yeast pathogen, data on the susceptibility of P. anomala to antifungal drugs are scarce (4,5,19,29,33). The aim of this study was to determine the in vitro susceptibility profile to five antifungal drugs of a large collection of P. anomala isolates from blood cultures of patients with nosocomial fungemia.For this purpose, 52 nonrelated bloodstream isolates of P. anomala (36 from Brazil, 13 from Argentina, and 3 from Spain) and 6 from unknown clinical specimens (United States) were tested by two broth microdilution methods, those of the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS) (21) and the European Committee on Antibiotic Susceptibility Testing (EUCAST) (37) guidelines.We evaluated the activity of amphotericin B (Sigma), itraconazole (Janssen Pharmaceutica), voriconazole (Pfizer, Inc.), and caspofungin (Merck & Co.) at concentrations ranging from 0.015 to 8 g/ml and of fluconazole (Pfizer, Inc.) at concentrations ranging from 0.12 to 64 g/ml.The inhibition criterion adopted to determine the MIC for amphotericin B was the lowest drug concentration which produced complete or nearly complete (Ն95%) inhibition compared with the drug-free control well (25). For azoles (21) and caspofungin (24), the lowest concentration which produced Ն50% inhibition was used.All MICs were determined spectrophotometrically (530 nm) after incubation for 24 h (EUCAST) or 48 h (CLSI). To categorize the isolates as susceptible, we employed the CLSI (21) interpretive criteria for fluconazole (Յ8 g/ml) and itraconazole (Յ0.12 g/ml); for voriconazole, we used a recently established breakpoint (BP) of Յ1 g/ml (30). Based on pharmacokinetic data, a BP of Յ1 g/ml was assumed for caspofungin (40) and for amphotericin B (22, 29). The CLSI interpretive criteria were also adopted for EUCAST results for comparison only, as EUCAST BPs have not been defined yet.In our study, we found an excellent agreement (Յ2-fold dilutions) between MIC results generated by the EUCAST and CLSI methods for all antifungal drugs (Table 1). The lowest agreement rate was observed for itraconazole assays,...

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“…Proper measurements would, however, require a prospective, well-designed study focused on this complex issue; measures of outcomes more sophisticated than a HAI may also be needed in the future to determine the optimal staff level and mix of skills [150].…”

Section: Limitations Regarding Data Collection (Ii-iv)mentioning

confidence: 99%

314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Pichia anomala outbreak in a nursery: exogenous source?

Abstract: Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.

Cited by 47 publications

References 21 publications

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

In Vitro Activity of Seven Systemically Active Antifungal Agents against a Large Global Collection of RareCandidaSpecies as Determined by CLSI Broth Microdilution Methods

Antifungal Drug Susceptibility Profile of Pichia anomala Isolates from Patients Presenting with Nosocomial Fungemia

314 Healthcare-Associated Infections in Pediatrics

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