Outbreak of Pichia anomala infection in the pediatric service of a tertiary-care center in Northern India

An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pedi atric emergency ward, with subsequent transmission to the premature nursery , pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for disseminat ion of the fungus. The outbreak could only be controlled after a health edu cation campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk in fants was introduced. In a case-control study, we identified a lower gestat ional age, a very low birth weight (<1,500 g), and a longer duration of hos pital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 conse cutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these ne onates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patien t and health care workers' hand isolates), and the results suggested that t hese isolates were identical. Our study highlights the importance of P. ano mala as an emerging nosocomial fungal pathogen.