Affiliation:
1. Third Department of Pediatrics
2. Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892
3. First Neonatology Department, Aristotle University of Thessaloniki
4. Microbiology Department, Hippokration Hospital, 54642 Thessaloniki, Greece
Abstract
ABSTRACT
From June to July 1998, two episodes of
Candida tropicalis
fungemia occurred in the Aristotle University neonatal intensive care unit (ICU). To investigate this uncommon event, a prospective study of fungal colonization and infection was conducted. From December 1998 to December 1999, surveillance cultures of the oral cavities and perinea of the 593 of the 781 neonates admitted to the neonatal ICU who were expected to stay for >7 days were performed. Potential environmental reservoirs and possible risk factors for acquisition of
C. tropicalis
were searched for. Molecular epidemiologic studies by two methods of restriction fragment length polymorphism analysis and two methods of random amplified polymorphic DNA analysis were performed. Seventy-two neonates were colonized by yeasts (12.1%), of which 30 were colonized by
Candida albicans
, 17 were colonized by
C. tropicalis
, and 5 were colonized by
Candida parapsilosis
. From December 1998 to December 1999, 10 cases of fungemia occurred; 6 were due to
C. parapsilosis
, 2 were due to
C. tropicalis
, 1 was due to
Candida glabrata
, and 1 was due to
Trichosporon asahii
(12.8/1,000 admissions). Fungemia occurred more frequently in colonized than in noncolonized neonates (
P
< 0.0001). Genetic analysis of 11 colonization isolates and the two late blood isolates of
C. tropicalis
demonstrated two genotypes. One blood isolate and nine colonization isolates belonged to a single type. The fungemia/colonization ratio of
C. parapsilosis
(3/5) was greater than that of
C. tropicalis
(2/17,
P
= 0.05), other non-
C. albicans Candida
spp. (1/11,
P
= 0.02), or
C. albican
s (0/27,
P
= 0.05). Extensive environmental cultures revealed no common source of
C. tropicalis
or
C. parapsilosis
. There was neither prophylactic use of azoles nor other risk factors found for acquisition of
C. tropicalis
except for total parenteral nutrition. A substantial risk of colonization by non-
C. albicans Candida
spp. in the neonatal ICU may lead to a preponderance of
C. tropicalis
as a significant cause of neonatal fungemia.
Publisher
American Society for Microbiology
Cited by
61 articles.
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