Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study

OBJECTIVE To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. DESIGN Case series study. SETTING A 2000-bed tertiary-care university hospital at São Paulo, Brazil. PARTICIPANTS Neonates hospitalised in a 63-bed neonatal unit. PRIMARY AND SECONDARY OUTCOME MEASURES We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. RESULTS During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. CONCLUSIONS The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA.