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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher.

ABSTRACT: Saprochaete clavata is a pathogenic yeast responsible for rare outbreaks involving immunocompromised patients, especially those with hematologic malignancies. During February 2016-December 2017, we diagnosed S. clavata infections in 9 patients (8 with fungemia), including 3 within 1 month, at a cancer center in Marseille, France. The patients (median age 58 years), 4 of 9 of whom had acute myeloid leukemia, were hospitalized in 3 different wards. Ten environmental samples, including from 2 dishwashers and 4 pitchers, grew S. clavata, but no contaminated food was discovered. The outbreak ended after contaminated utensils and appliances were discarded. Whole-genome sequencing analysis demonstrated that all clinical and environmental isolates belonged to the same phylogenetic clade, which was unrelated to clades from previous S. clavata outbreaks in France. We identified a dishwasher with a deficient heating system as the vector of contamination.

SUBMITTER: Menu E

PROVIDER: S-EPMC7454083 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher.

Menu Estelle E Criscuolo Alexis A Desnos-Ollivier Marie M Cassagne Carole C D'Incan Evelyne E Furst Sabine S Ranque Stéphane S Berger Pierre P Dromer Françoise F

Emerging infectious diseases 20200901 9

Saprochaete clavata is a pathogenic yeast responsible for rare outbreaks involving immunocompromised patients, especially those with hematologic malignancies. During February 2016-December 2017, we diagnosed S. clavata infections in 9 patients (8 with fungemia), including 3 within 1 month, at a cancer center in Marseille, France. The patients (median age 58 years), 4 of 9 of whom had acute myeloid leukemia, were hospitalized in 3 different wards. Ten environmental samples, including from 2 dishw ...[more]

PMID: 32818391

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Project description:UnlabelledRapidly fatal cases of invasive fungal infections due to a fungus later identified as Saprochaete clavata were reported in France in May 2012. The objectives of this study were to determine the clonal relatedness of the isolates and to investigate possible sources of contamination. A nationwide alert was launched to collect cases. Molecular identification methods, whole-genome sequencing (WGS), and clone-specific genotyping were used to analyze recent and historical isolates, and a case-case study was performed. Isolates from thirty cases (26 fungemias, 22 associated deaths at day 30) were collected between September 2011 and October 2012. Eighteen cases occurred within 8 weeks (outbreak) in 10 health care facilities, suggesting a common source of contamination, with potential secondary cases. Phylogenetic analysis identified one clade (clade A), which accounted for 16/18 outbreak cases. Results of microbiological investigations of environmental, drug, or food sources were negative. Analysis of exposures pointed to a medical device used for storage and infusion of blood products, but no fungal contamination was detected in the unused devices. Molecular identification of isolates from previous studies demonstrated that S. clavata can be found in dairy products and has already been involved in monocentric outbreaks in hematology wards. The possibility that S. clavata may transmit through contaminated medical devices or can be associated with dairy products as seen in previous European outbreaks is highly relevant for the management of future outbreaks due to this newly recognized pathogen. This report also underlines further the potential of WGS for investigation of outbreaks due to uncommon fungal pathogens.ImportanceSeveral cases of rapidly fatal infections due to the fungus Saprochaete clavata were reported in France within a short period of time in three health care facilities, suggesting a common source of contamination. A nationwide alert collected 30 cases over 1 year, including an outbreak of 18 cases over 8 weeks. Whole-genome sequencing (WGS) was used to analyze recent and historical isolates and to design a clade-specific genotyping method that uncovered a clone associated with the outbreak, thus allowing a case-case study to analyze the risk factors associated with infection by the clone. The possibility that S. clavata may transmit through contaminated medical devices or can be associated with dairy products as seen in previous European outbreaks is highly relevant for the management of future outbreaks due to this newly recognized pathogen.

Project description:BackgroundCommunity Outreach and Engagement (COE) teams at National Cancer Institute-designated comprehensive cancer centers are tasked with engaging communities to understand and address the burden of cancer within their catchment area. This helps cancer center leadership identify priorities and develop strategic plans to reduce the cancer burden. University of Iowa Health Care Holden Comprehensive Cancer Center collaborates with its Community Advisory Board (CAB) to understand the needs and priorities of its catchment area, the state of Iowa.MethodsThe Holden Comprehensive Cancer Center's CAB is made up of diverse individuals from across the state, including community leaders and representatives from local hospitals, health departments, and nonprofits, who are dedicated to partnering with Holden Cancer Center to reduce the state's cancer burden. Holden Cancer Center's COE team engaged its CAB in conversations to establish a process to identify research, clinical, and outreach priorities for the Holden Cancer Center. Small- and whole-group dialogues during CAB meetings helped gauge important criteria for determining priorities. The COE team also conducted online surveys to quantitatively assess CAB perspectives on guiding criteria for Holden Cancer Center to consider when identifying priorities.ResultsOver the course of three interactive meetings, CAB members refined and ranked criteria for selecting Holden Cancer Center priorities. The top guiding criteria identified by CAB members included barriers patients face to cancer treatment, screening, or clinical trials; preventable cancers; and achieving health equity or correcting health disparities in the state.ConclusionThe COE team, Holden Cancer Center leadership, and CAB members are exploring avenues to inform Holden Cancer Center research and program planning with priorities developed using the CAB-identified guiding criteria. The multi-step process employed by Holden Cancer Center to engage community members in the identification and creation of priorities can be adapted by other cancer centers to ensure that institutional and community priorities are aligned.

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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher.

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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher.

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