Detection of neonatal unit clusters of Candida parapsilosis fungaemia by microsatellite genotyping: Results from laboratory‐based sentinel surveillance, South Africa, 2009‐2010

Abstract

Neonatal candidaemia is a common, deadly and costly hospital-associated disease. To determine the genetic diversity of Candida parapsilosis causing fungaemia in South African neonatal intensive care units (NICUs). From February 2009 through to August 2010, cases of candidaemia were reported through laboratory-based surveillance. C. parapsilosis isolates from neonatal cases were submitted for identification by internal transcribed spacer (ITS) region sequencing, antifungal susceptibility testing and microsatellite genotyping. Cluster analysis was performed using Unweighted Pair Group Method with Arithmetic Mean (UPGMA). Of 1671 cases with a viable Candida isolate, 393 (24%) occurred among neonates. Isolates from 143 neonatal cases were confirmed as C. parapsilosis sensu stricto. Many isolates were resistant to fluconazole (77/143; 54%) and voriconazole (20/143; 14%). Of 79 closely-related genotypes, 18 were represented by ≥2 isolates; 61 genotypes had a single isolate each. Seven clusters, comprised of 82 isolates, were identified at five hospitals in three provinces. Isolates belonging to certain clusters were significantly more likely to be fluconazole resistant: all cluster 7 isolates and the majority of cluster 4 (78%), 5 (89%) and 6 (67%) isolates (P<.001). Candida parapsilosis-associated candidaemia in public-sector NICUs was caused by closely related genotypes and there was molecular evidence of undetected outbreaks as well as intra-hospital transmission.

Approach to the Investigation and Management of Patients With Candida auris, an Emerging Multidrug-Resistant Yeast

“…Control of the outbreak required implementation of aggressive infection control practices, including use of contact precautions and thrice-daily room disinfection with bleach. Although outbreaks of Candida parapsilosis have been reported, Candida infections are usually thought to result from autoinfection with host flora rather than transmission from external sources [16, 17]. The U.K. outbreak clearly demonstrated that C. auris can be transmitted in healthcare settings [18].…”

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

“…Associated with these changes have been reports of candidaemia largely clonal outbreaks due to azole‐resistant Candida spp. in critically ill patients …”

“…in critically ill patients. [6][7][8][9][10] Because of these issues, the need for sensitive non-culture-based diagnostic assays with improved turnaround times became critical. The 1,3-beta-D-glucan (BDG) is a broad fungal detection antigen which has been used as an adjunct in the diagnosis of invasive fungal infections worldwide for more than a decade with numerous publications illustrating its use in various clinical settings.…”

Bridging the knowledge gap on mycoses in Africa: Setting up a Pan‐African Mycology Working Group

“…In contrast, the epidemiology of mycetoma, cryptococcosis, emergomycosis and Candida auris has been better described in some areas. This is due to (a) extensive work that has been done and is still ongoing as Candida auris 22 and Candida parapsilosis 23 ). The recent revolution in non-culture-based diagnostics has yet to penetrate in Africa, with the one partial exception of cryptococcal antigen testing.…”

“…In contrast, the epidemiology of mycetoma, cryptococcosis, emergomycosis and Candida auris has been better described in some areas. This is due to (a) extensive work that has been done and is still ongoing by van de Sande and Fahal research teams (mycetoma in Sudan) which has led to the establishment of a WHO Collaborating Centre in Sudan; (b) the relationship of HIV/AIDS (sub‐Saharan Africa bears a significant part of the burden globally) and cryptococcal meningitis; and (c) the presence of a defined public health agenda, a mycology reference laboratory and national surveillance network in South Africa, which has aided Govender and other researchers to describe the epidemiology of emergomycosis, cryptococcal meningitis and candidaemia (caused by emerging azole‐resistant pathogens such as Candida auris and Candida parapsilosis ). The recent revolution in non‐culture‐based diagnostics has yet to penetrate in Africa, with the one partial exception of cryptococcal antigen testing.…”