Pseudooutbreak of Candida guilliermondii fungemia in a neonatal intensive care unit

Pablo Yagupsky, Ron Dagan, Miriam Chipman, Anna Goldschmied-Reouven, Ehud Zmora, Michael Karplus

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

During a 3-week period multiple blood cultures obtained from 14 Neonatal Intensive Care Unit infants and 3 Newborn Unit babies grew Candida guilliermondii, a yeast rarely associated with infections in humans. At the time of detection of positive cultures, most infants had been hospitalized for days or weeks for serious perinatal conditions and treated with antibiotics and intravenous hyperalimentation. Two critically ill premature infants from whom the yeast was isolated were given amphotericin B. In 7 other infants, however, yeasts were recovered on the day of birth, raising the question of pseudofungemia. Exhaustive interrogation on the blood culture practices revealed that when drawing blood for a culture from small infants, “butterfly” needles were often flushed with a diluted heparin solution to prevent blood clotting. Culture of a single lot of diluted heparin vials, prepared at the hospital pharmacy and distributed to the Neonatal Intensive Care Unit and Newborn Unit shortly before the onset of the epidemic, grew between 10 000 and 15 000 colony-forming units of Candida guilliermondii dii/ml. Removal of contaminated heparin vials and discontinuation of heparinization of needles used for blood cultures resulted in cessation of the epidemic. The present outbreak illustrates the difficulties in recognizing pseudoinfections in sick premature infants and the importance of intensive investigation and intervention during such an outbreak.

Original languageEnglish
Pages (from-to)928-932
Number of pages5
JournalPediatric Infectious Disease
Volume10
Issue number12
DOIs
StatePublished - 1 Jan 1991

Keywords

  • Candida guilliermondii
  • Neonatal
  • Pseudofungemia

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