TY - JOUR AU - van Schalkwyk, Erika AU - Iyaloo, Samantha AU - Naicker, Serisha AU - Maphanga, Tsidiso AU - Mpembe, Ruth AU - Zulu, Thokozile AU - Mhlanga, Mabatho AU - Mahlangu, Sibongile AU - Maloba, Motlatji AU - Ntlemo, Grace AU - Sanyane, Kgomotso AU - Mawela, Dini AU - Govender, Nelesh T1 - Large Outbreaks of Fungal and Bacterial Bloodstream Infections in a Neonatal Unit, South Africa, 2012–2016 T2 - Emerging Infectious Disease journal PY - 2018 VL - 24 IS - 7 SP - 1204 SN - 1080-6059 AB - Candidemia is a major cause of healthcare-associated infections. We describe a large outbreak of Candida krusei bloodstream infections among infants in Gauteng Province, South Africa, during a 4-month period; a series of candidemia and bacteremia outbreaks in the neonatal unit followed. We detected cases by using enhanced laboratory surveillance and audited hospital wards by environmental sampling and epidemiologic studies. During July–October 2014, among 589 patients, 48 unique cases of C. krusei candidemia occurred (8.2% incidence). Risk factors for candidemia on multivariable analyses were necrotizing enterocolitis, birthweight <1,500 g, receipt of parenteral nutrition, and receipt of blood transfusion. Despite initial interventions, outbreaks of bloodstream infection caused by C. krusei, rarer fungal species, and bacterial pathogens continued in the neonatal unit through July 29, 2016. Multiple factors contributed to these outbreaks; the most functional response is to fortify infection prevention and control. KW - disease outbreaks KW - fungi KW - candidemia KW - Candida krusei KW - bloodstream KW - neonatal sepsis KW - infant KW - newborn KW - prematurity KW - fungemia KW - bacteremia KW - bacteria KW - cross-infection KW - infection control KW - antibacterial KW - antifungal KW - blood transfusion KW - intravenous KW - fomite KW - nosocomial KW - central venous catheter KW - necrotizing enterocolitis KW - Gauteng KW - South Africa DO - 10.3201/eid2407.171087 UR - https://wwwnc.cdc.gov/eid/article/24/7/17-1087_article ER - End of Reference