A sudden rise of Candida krusei candidemia cases was noticed in our hospital within 1 year with maximum cases from paediatric unit. The present study reports the results of epidemiological investigation of possible outbreak of candidemia by C. krusei in paediatric unit at our tertiary care centre. Clinical characteristics and risk factors associated with C. krusei candidemia were evaluated. Yeast identification and antifungal susceptibility testing was performed according to standard protocol. To find the potential source of C. krusei in hospital environment and hand colonization, swabs were collected from different fomites (n = 40) and hand washings from 24 health care workers (HCW), respectively. Infection control and prevention practices were intensified following the recognition of outbreak. Genetic typing was done by fluorescent amplified fragment length polymorphism (FAFLP) technique. Case–control comparison was performed with C. tropicalis and C. pelliculosa cases. Candida krusei fungaemia significantly affected paediatric group (82/186, 44%) as compared to adults (14/130, 10.8%; p < 0.001). Among paediatric group, maximum isolation was reported from neonatal unit of paediatric emergency (NUPE). C. krusei was isolated from hands of one HCW and washbasin in NUPE. FAFLP revealed clonality between blood and environmental isolates indicating cross-transmission of C. krusei. Gastrointestinal disease (p = 0.018), previous antibiotics (p = 0.021) especially to carbapenems (p = 0.039), was significant among C. krusei candidemia cases compared to C. pelliculosa cases. We report the largest outbreak of C. krusei candidemia in paediatric unit within 1 year with isolation of related strains from environment and hands of HCW. Routine screening of hand hygiene practices revealed non-compliance to standard practices leading to the increase in C. krusei candidemia cases.

中文翻译：

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三级医院儿科病房克柔念珠菌念珠菌病长期暴发

我院1年内发现克柔念珠菌念珠菌血症病例突然增加，其中儿科病例最多。本研究报告了对我们三级医疗中心儿科病房中克柔念珠菌可能爆发的念珠菌血症的流行病学调查结果。评估了与克柔念珠菌病相关的临床特征和危险因素。根据标准方案进行酵母鉴定和抗真菌药敏试验。为了在医院环境和手部定植中寻找克柔念珠菌的潜在来源，分别从不同的污染物（n = 40）和 24 名卫生保健工作者 (HCW) 的洗手液中收集了拭子。发现疫情后，加强了感染控制和预防措施。通过荧光扩增片段长度多态性（FAFLP）技术进行基因分型。病例对照比较是用热带念珠菌和厚皮念珠菌病例进行的。与成人 (14/130, 10.8%; p < 0.001) 相比，克柔念珠菌真菌血症显着影响儿科组 (82/186, 44%)。在儿科组中，最大程度的隔离来自儿科急诊新生儿科 (NUPE)。C. krusei 从 NUPE 的一名医护人员和洗脸盆的手上分离出来。FAFLP 揭示了血液和环境分离株之间的克隆性，表明克柔念珠菌的交叉传播。与 C. pelliculosa 病例相比，胃肠道疾病 (p = 0.018)、先前的抗生素 (p = 0.021) 尤其是碳青霉烯类 (p = 0.039) 在克柔念珠菌病病例中显着。我们报告了最大规模的 C. 1 年内在儿科病房出现 krusei 念珠菌血症，并从环境和医护人员手中分离出相关菌株。手卫生习惯的常规筛查显示不遵守标准做法导致克柔念珠菌病病例增加。