NONPERINATAL NOSOCOMIAL TRANSMISSION OF CANDIDA-ALBICANS IN A NEONATAL INTENSIVE-CARE UNIT - PROSPECTIVE-STUDY

Nosocomial Candida albicans infections have become a major cause of mo rbidity and mortality in neonates in neonatal intensive care units (NI CUs). To determine the possible modes of acquisition of C. albicans in hospitalized neonates, we conducted a prospective study at Grady Memo rial Hospital, Atlanta, Ga. Clinical samples for fungal surveillance c ultures were obtained at birth from infants (mouth, umbilicus, and gro in) and their mothers (mouth and vagina) and were obtained from infant s weekly until they were discharged. All infants were culture negative for C. albicans at birth. Six infants acquired C. albicans during the ir NICU stay. Thirty-four (53%) of 64 mothers were C. albicans positiv e (positive at the mouth, n = 26; positive at the vagina, 18; positive at both sites, n = 10) at the time of the infant's delivery. A total of 19 C. albicans isolates were analyzed by restriction endonuclease a nalysis and restriction fragment length polymorphism analysis by using genomic blots hybridized with the CARE-2 probe. Of the mothers positi ve for C. albicans, 3 of 10 were colonized with identical strains at t wo different body sites, whereas 7 of 10 harbored nonidentical strains at the two different body sites. Four of six infants who acquired C. albicans colonization in the NICU had C. albicans-positive mothers; sp ecimens from all mother-infant pairs had different restriction endonuc lease and CARE-2 hybridization profiles. One C. albicans-colonized inf ant developed candidemia; the colonizing and infecting strains had ide ntical banding patterns. Our study indicates that nonperinatal nosocom ial transmission of C. albicans is the predominant mode of acquisition by neonates in NICUs at this hospital; mothers may be colonized with multiple strains of C. albicans simultaneously; colonizing C. albicans strains can cause invasive disease in neonates; and molecular biology -based techniques are necessary to determine the epidemiologic related ness of maternal and infant C. albicans isolates and to facilitate det ermination of the mode of transmission.