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Background Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. When a cluster of patients with Malassezia pachydermatis infection was identified in an intensive care nursery, we initiated an investigation.
Methods A case patient was defined as any infant in the intensive care nursery who had a positive culture for M. pachydermatis between October 17, 1993, and January 18, 1995. We conducted a cohort study to identify risk factors for colonization and infection with M. pachydermatis. We collected cultures from the infants and the health care workers and from the health care workers' pets, since this organism has been associated with otitis externa in dogs.
Results Fifteen infants met the case definition: eight with bloodstream infections, two with urinary tract infections, one with meningitis, and four with asymptomatic colonization. The case patients were significantly more likely than the other infants to weigh 1300 g or less (15 of 65 vs. 0 of 419, P<0.001). In a multivariate analysis of infants weighing 1300 g or less, the independent risk factors for colonization or infection with M. pachydermatis were a greater severity of concomitant illness (odds ratio, 19.7; P = 0.001), arterial catheterization for nine or more days (odds ratio, 29.5; P = 0.02), and exposure to Nurse A (odds ratio, 74.7; P = 0.01). In a point-prevalence survey, 9 additional infants, 1 health care worker, and 12 of the health care workers' pet dogs had positive cultures for M. pachydermatis. The isolates from all 15 case patients, the 9 additional colonized infants, 1 health care worker, and 3 of the 12 dogs had identical patterns of restriction-fragment–length polymorphisms.
Conclusions In this outbreak, it is likely that M. pachydermatis was introduced into the intensive care nursery on health care workers' hands after being colonized from pet dogs at home. The organism persisted in the nursery through patient-to-patient transmission.
Source Information
From the Hospital Infections Program (H.J.C., H.L.M., M.J.A., S.M.A., W.R.J.), and the Division of Bacterial and Mycotic Diseases (D.A.A., M.M.M.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; the Robert Wood Johnson Clinical Scholars Program, University of Chicago, and the University of Illinois at Chicago — both in Chicago (H.J.C.); the Dartmouth–Hitchcock Medical Center, Lebanon, N.H. (N.W., R.P.-P., C.F.v.R., W.E.); and St. Thomas' Hospital, London (G.M.). Ruth Pruitt, M.S. (Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta) was also an author.
Address reprint requests to Dr. Jarvis at the Hospital Infections Program, Mailstop E-69, Centers for Disease Control and Prevention, Atlanta, GA 30333.
Related Letters:
Malassezia pachydermatis Infections
Lautenbach E., Nachamkin I., Schuster M. G., Groshek P. M., Lester T. J., Chang H. J., von Reyn C. F., Jarvis W. R., Marcus L. C., Marcus E.
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Full Text
N Engl J Med 1998;
339:270-271, Jul 23, 1998.
Correspondence
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