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. 2020 Apr;185(2):257-268.
doi: 10.1007/s11046-020-00427-y. Epub 2020 Jan 25.

Prolonged Outbreak of Candida krusei Candidemia in Paediatric Ward of Tertiary Care Hospital

Harsimran Kaur  1 , Shamanth A Shankarnarayana  1 , Vinaykumar Hallur  2 , Jayashree Muralidharan  3 , Manisha Biswal  1 , Anup K Ghosh  1 , Pallab Ray  1 , Arunaloke Chakrabarti  1 , Shivaprakash M Rudramurthy  4
Affiliations

Prolonged Outbreak of Candida krusei Candidemia in Paediatric Ward of Tertiary Care Hospital

Harsimran Kaur et al. Mycopathologia. 2020 Apr.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Candida krusei; Candidemia; Molecular typing; Outbreak; Paediatrics.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart showing different wards with the number of beds and C. krusei cases in each ward and ICUs
Fig. 2
Fig. 2
Month-wise distribution of paediatric candidemia cases by C. krusei, C. tropicalis and C. pelliculosa
Fig. 3
Fig. 3
Ward-wise distribution of paediatric candidemia cases by C. krusei
Fig. 4
Fig. 4
Year-wise trend in paediatric candidemia cases caused by C. krusei and hand hygiene compliance in paediatric units
Fig. 5
Fig. 5
Fingerprint profile generated by FAFLP analysis of C. krusei isolated from blood and environment in the year 2014
Fig. 6
Fig. 6
Fingerprint profile generated by FAFLP analysis of C. krusei isolated over different years
See this image and copyright information in PMC

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