Pichia anomala outbreak in a nursery: exogenous source?

Background. Pichia anomala is a rare cause of fungemia. From February to Ap ril, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infectio n, one of whom also had Candida parapsilosis infection, two cases with C. p arapsilosis infection and two with Candida albicans infection. Objective. To determine factors associated with fungemia in the intensive c are and high risk units of the Nursery, especially P. anomala. Methods. A cohort study with 59 newborns. Results. Factors associated with fungemia were: central venous catheter (CV C) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emuls ion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN fo rmulation and education as to adequate technique were implemented. During f ollow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Elec trophoretic karyotyping of P. anomala showed three profiles. Conclusions. Factors associated with fungemia were catheter use, invasive p rocedures and total parenteral nutrition, suggesting that the acquisition o f P. anomala was exogenous.