NOSOCOMIAL MALASSEZIA-PACHYDERMATIS BLOOD-STREAM INFECTIONS IN A NEONATAL INTENSIVE-CARE UNIT

Malassezia pachydermatis, a lipophilic yeast, has been described to ca use sporadic nosocomial bloodstream infections (BSI). Nosocomial outbr eaks of M. pachydermatis BSI have never been described. A cluster of M . pachydermatis BSIs in the neonatal intensive care unit at Louisiana State University Medical Center, University Hospital provided the oppo rtunity to investigate the epidemiology of this organism and apply mol ecular epidemiologic typing techniques. A case-patient was defined as any neonatal intensive care unit patient in University Hospital with a blood culture positive for M. pachydermatis from January 1, 1989, thr ough August 15, 1991. Five patients met the case definition. Case-pati ents were premature as estimated by gestational age and required prolo nged hospitalization. Case-patients received parenteral nutrition and intravenous lipids for twice as many days as randomly selected control s. No environmental source of M. pachydermatis was identified; however , infants on each side of a previously identified M. pachydermatis-col onized infant became colonized with M. pachydermatis during a 20-day p eriod. Chromosomal analysis of five M. pachydermatis blood isolates fr om two case-patients had identical banding patterns. These data show t hat M. pachydermatis can cause nosocomial BSI outbreaks, that prematur e infants receiving parenteral nutrition and/or lipids may be at great est risk and that transmission is most likely from person to person, p robably via the hands of medical personnel.