A prospective survey for central line skin-site colonization by the pathogen Malassezia furfur among hospitalized adults receiving total parenteral nutrition

Background: Over 50 case reports suggest that Malassezia furfur is an emerging systemic pathogen in neonates who receive IV lipid emulsions. Because isolation of this fungus requires special culture techniques, which are not routinely used, the authors of many case reports of M. furfur infections in adults question whether infections caused by this organism are being underdiagnosed in older patients. Methods: Catheter insertion site colonization rates in adults receiving total parenteral nutrition (TPN) were prospectively evaluated in 149 hospitalized patients with 928 cultures handled specifically for M. furfur detection. Positive control samples consisted of M. furfur cultures in neonates and in adults, who had not been enrolled in the study, and of a separate positive culture obtained from a skin site inoculated with M. furfur. Results: M. furfur was not cultured from any of the 928 study samples (95% confidence interval [CI] -0.4% to +0.4%). Conclusions: These results suggest that M. furfur less of a threat to hospitalized adults receiving TPN than has been otherwise postulated. These data do not support the inclusion of special cultures for M. furfur in routine skin-site surveillance programs among hospitalized adults receiving TPN.