Large outbreaks of fungal and bacterial bloodstream infections in a neonatal unit, South Africa, 2012–2016

Erika van Schalkwyk*, Samantha Iyaloo, Serisha D. Naicker, Tsidiso G. Maphanga, Ruth S. Mpembe, Thokozile G. Zulu, Mabatho Mhlanga, Sibongile Mahlangu, Motlatji B. Maloba, Grace Ntlemo, Kgomotso Sanyane, Dini Mawela, Nelesh P. Govender

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1204-1212
Number of pages9
JournalEmerging Infectious Diseases
Issue number7
Publication statusPublished - Jul 2018
Externally publishedYes


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