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Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher

Abstract : S aprochaete clavata (previously Geotrichum clavatum) is a rare emerging pathogen, an ascomycetous yeast-producing arthroconidia that causes invasive fungal infections in immunocompromised patients. The species has mainly been reported in Europe, often associated with sporadic cases or small outbreaks (1,2). Unlike Magnusiomyces capitatus (3,4), which has been associated with dairy products, S. clavata has rarely been isolated from environmental samples (5,6). Patients most at risk for infections from Geotrichum spp. have hematologic diseases with severe neutropenia (7) and are undergoing chemotherapy, mainly with cytarabine (1) or caspofungin (8). They often have central venous catheters (9). In recent years, S. clavata fungemia outbreaks associated with high mortality rates in vulnerable patients with malignancies have been described throughout Europe, mainly in France (1), Italy (2,10), Czechia (11), and Spain (12). No source of contamination was identified in any of these outbreaks despite thorough investigation. During February 2016-December 2017, the Paoli-Calmettes Institute, a cancer center in Marseille, France, was faced with an outbreak of S. clavata infections involving 9 patients hospitalized in 3 different wards, suggesting a common source of contamination. We describe the findings of an outbreak investigation that recovered S. clavata in different environmental samples, including from a dishwasher in the central kitchen and another, available to patients and their families, in the stem-cell transplant ward. Whole-genome sequencing (WGS) confirmed that the environmental and clinical isolates from patients belonged to the same phylogenetic clade. Handwashing, avoiding direct skin contact, checking air quality, and sterilizing food are routine practice to prevent contamination in hematology wards; however, examining dishwashers for contamination and operability may not be done routinely. Our findings should prompt adding dishwasher inspections to guidelines for preventing infection. Materials and Methods Case Definition Criteria We defined S. clavata infection by obtaining ≥1 positive results for S. clavata blood culture from a usually sterile body site or from a bronchoalveolar lavage or tracheal aspirate of the respiratory tract. Infection was also confirmed by observing pleural fluid in a patient with pleural effusion or lung infection.
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Estelle Menu, Alexis Criscuolo, Marie Desnos-Ollivier, Carole Cassagne, Evelyne D’incan, et al.. Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher. Emerging Infectious Diseases, Centers for Disease Control and Prevention, 2020, 26 (9), pp.2031-2038. ⟨10.3201/eid2609.200341⟩. ⟨hal-03165193⟩

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