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An Outbreak of Pichia anomala Fungemia in a Brazilian Pediatric Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Alessandro Comarú Pasqualotto ,
Teresa Cristina Teixeira Sukiennik ,
Luiz Carlos Severo ,
Cledja Soares de Amorim  and
Arnaldo Lopes Colombo
Alessandro Comarú Pasqualotto*
Affiliation:
School of Medicine, University of Manchester, Manchester, United Kingdom; Department of Infection Control, Santa Casa Complexo Hospitalar, Porto Alegre, RS, Brazil
Teresa Cristina Teixeira Sukiennik
Affiliation:
Department of Infection Control, Santa Casa Complexo Hospitalar, Porto Alegre, RS, Brazil
Luiz Carlos Severo
Affiliation:
Clinical Mycology Laboratory, Santa Casa Complexo Hospitalar, Porto Alegre, RS, Brazil
Cledja Soares de Amorim
Affiliation:
Mycology Laboratory, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
Arnaldo Lopes Colombo
Affiliation:
Mycology Laboratory, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
*
1/512 Wilmslow Road, Manchester, M20 4BT, United Kingdom. alessandro.pasqualotto@manchester.ac.uk
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Abstract

Objective:

To report an outbreak of Pichia anomala fungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.

Design:

Unmatched case-control study.

Methods:

We randomly selected four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.

Results:

During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developed P. anomala fungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated with P. anomala fungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients with P. anomala fungemia and control-patients with candidemia.

Conclusions:

This study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen. Patients with P. anomala fungemia seem to have risk factors in common with those who have candidemia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 6 , June 2005 , pp. 553 - 558
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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