NEONATAL CANDIDA-PARAPSILOSIS OUTBREAK WITH A HIGH CASE-FATALITY RATE

A Candida parapsilosis outbreak of 58 cases in a neonatal intensive ca re unit lasted for 55 months. Patients infected by or colonized with C . parapsilosis were mainly very low birth weight infants (birth weight <1500 g). Their mean birth weight was 817 g and their mean gestationa l age was 28 weeks. Statistical analysis including logistic regression confirmed that prematurity was the main risk factor. The analysis als o suggested that C. parapsilosis infection (or colonization) was assoc iated with a poor prognosis. In infants with gestational age <29 weeks the risk for death in C. parapsilosis-infected patients was 16-fold g reater than in those with no C. parapsilosis infection. The case fatal ity rate of C. parapsilosis patients was higher than that of the contr ols (9 of 23 vs. 1 of 40; P < 0.0001). The outbreak was most likely a result of cross-infection because C. parapsilosis could be isolated on ly from the patients and from the hands of four nurses immediately aft er they had cared for a colonized patient. Cessation of the outbreak w as temporally associated with long term parenteral fluconazole (6 mg/k g/day) prophylaxis.