Candida parapsilosis bloodstream infections in neonatal intensive care unit patients: epidemiologic and laboratory confirmation of a common source outbreak

Pediatr Infect Dis J. 1996 Nov;15(11):998-1002. doi: 10.1097/00006454-199611000-00013.


Background: Candida parapsilosis is a common cause of sporadic and epidemic infections in neonatal intensive care units (NICUs). When a cluster of C. parapsilosis bloodstream infections occurred in NICU patients in a hospital in Louisiana, it provided us with the opportunity to conduct an epidemiologic investigation and to apply newly developed molecular typing techniques.

Methods: A case-patient was defined as any NICU patient at Louisiana State University Medical Center, University Hospital, with a blood culture positive for C. parapsilosis during July 20 to 27, 1991. To identify risk factors for C. parapsilosis bloodstream infection, a cohort study of all NICU infants admitted during July 17 to 27, 1991, was performed. Electrophoretic karyotyping was used to assess the relatedness of C. parapsilosis isolates.

Results: The receipt of liquid glycerin given as a suppository was identified as a risk factor (relative risk, 31.2; 95% confidence intervals, 4.3 to 226.8). Glycerin was supplied to the NICU in a 16-oz multidose bottle. Bottles used at the time of the outbreak were not available for culture. All six available isolates from four case-patients had identical chromosomal banding patterns; six University Hospital non-outbreak isolates had different banding patterns.

Conclusions: This study demonstrates the utility of combined epidemiologic and laboratory techniques in identifying a novel common source for a C. parapsilosis bloodstream infection outbreak and illustrates that extreme caution should be exercised when using multidose medications in more than one patient.

MeSH terms

  • Candida / genetics
  • Candida / isolation & purification*
  • Candidiasis / diagnosis
  • Candidiasis / epidemiology*
  • Cross Infection / diagnosis
  • Cross Infection / epidemiology*
  • Electrophoresis
  • Fungemia / diagnosis
  • Fungemia / epidemiology*
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Karyotyping
  • Molecular Epidemiology
  • Mycological Typing Techniques
  • Risk Factors