Abstract
Fungemia in preterm infants results in high mortality and morbidity. The genotypes, drug susceptibilities of Candida pelliculosa strains, and clinical features of two outbreaks of neonatal candidemia caused by C. pelliculosa were analyzed, in order to provide evidence for the outbreaks and characteristics of C. pelliculosa neonatal candidemia. The strains were genotyped by pulsed-field gel electrophoresis to investigate their genetic relatedness. The broth microdilution method was used to determine in vitro susceptibility of the isolates to antifungal drugs. Clinical features of the infected patients were collected to analyze the risks for C. pelliculosa infection. Fourteen neonates, hospitalized in the neonatal intensive care unit from November 2012 to October 2013, were infected by C. pelliculosa. All 14 patients were cured after treatment with fluconazole and discharged without any complications. The C. pelliculosa isolates from the 14 patients were clustered into two groups, indicating that the outbreaks were caused by two types of strains. Eight of nine strains isolated from the 2013 outbreak were clustered into the same group, while one isolate was grouped together with five isolates from the 2012 outbreak. In vitro experiments demonstrated high antifungal activity of fluconazole, voriconazole, amphotericin B, and 5-fluorocytosine to C. pelliculosa. The common symptoms of C. pelliculosa candidaemia were fever, cyanosis, polypnea, hypoactivity, and apnea. The current study revealed high in vitro susceptibility of C. pelliculosa to antifungals. As C. pelliculosa candidaemia cannot be characterized by clinical symptoms and routine blood testing alone, monitoring unusual strains isolated from immunodeficient hosts is very important to prevent possible outbreaks.
Highlights
Fungemia in preterm infants results in high mortality and morbidity
Five patients were admitted within 17 days in November 2012, and nine patients were diagnosed with C. pelliculosa fungemia from July 2013 to October 2013, among which seven patients were admitted within four days
Several outbreaks of C. pelliculosa fungemia have been reported in neonatal intensive care unit (NICU) [11,12,24], C. pelliculosa is rare in neonatal candidaemia [12]
Summary
The genotypes, drug susceptibilities of Candida pelliculosa strains, and clinical features of two outbreaks of neonatal candidemia caused by C. pelliculosa were analyzed, in order to provide evidence for the outbreaks and characteristics of C. pelliculosa neonatal candidemia. Candidemia is caused by Candida species and has severe complications in premature and low-birthweight infants; it is the third most common nosocomial bloodstream infection during late-onset neonatal sepsis [1], with an overall incidence of 0.3–9.9% and a mortality of 30–60% in the neonatal intensive care unit (NICU) [2,3,4]. Candida pelliculosa (former names: Pichia anomala, Hansenula anomala) is mainly found in plants and oil, and was first reported as the cause of an NICU outbreak of fungemia in 1986 [8] that infected immunocompromised patients, especially those with acquired immunodeficiency syndrome (AIDS) and cancer [9,10].
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