A rare yeast pathogen known as Lodderomyces elongisporus, which typically infects immunocompromised adult patients or intravenous drug users, is now causing infections in premature infants in neonatal intensive care units in Delhi. The pathogen is highly resistant to disinfectants commonly used in hospital rooms, making it difficult to contain outbreaks.
According to a study published in the journal mBio, infected patients can be treated with antifungal medications, but the yeast is resistant to the strong disinfectant bleach commonly used to sanitize hospital rooms. The pathogen is evolving quickly and reproducing at a much higher rate than related pathogens such as Candida auris, a drug-resistant fungus that can cause persistent and severe infections and widespread outbreaks.
Clusters of infection occurred in the fall of 2021 and in early 2022 in a Delhi neonatal intensive care unit, despite repeated deep cleaning. Ten infants were infected over six months, but nine survived after being treated with antifungal medications. The researchers found that the railing and temperature-control panel of the open care warmer were contaminated with L. elongisporus.
Through genome sequencing, the team determined there were two closely related genotype clusters – one which spread from infant to infant and another found on the hospital equipment. Further testing showed a close relationship between the hospital strains and those found in the wider world on the surface of apples, suggesting fruits as a possible source of transmission.
The findings are worrisome because the hospital environment seems to be selecting for stress-resistant fungal pathogens. “The genetic mechanisms underlying their adaptations to humans, and to hospital and natural environments warrant further investigation and measures to contain their spread and persistence,” said Jianping Xu, a professor at McMaster University and a lead author of the study.
If these pathogens can be stopped from entering into hospital environments where many immunocompromised people are, then there is a much higher chance of controlling them, the researchers added. The study highlights the need for improved infection control measures in neonatal intensive care units to prevent outbreaks of fungal infections that can cause severe illness and death in vulnerable premature infants.