Multicenter Outbreak of Infections by
Saprochaete clavata
, an Unrecognized Opportunistic Fungal Pathogen
Authors: Vaux Sophie , Criscuolo Alexis , Desnos-Ollivier Marie , Diancourt Laure , Tarnaud Chloé , Vandenbogaert Matthias , Brisse Sylvain , Coignard Bruno , Dromer Françoise ,   The Geotrichum Investigation Group, Garcia-Hermoso Dea , Blanc Catherine , Hoinard Damien , Lortholary Olivier , Bretagne Stéphane , Thiolet Jean-Michel , de Valk Henriette , Courbil Rémi , Chabanel Anne , Simonet Marion , Maire Francoise , Jbilou Saadia , Tiberghien Pierre , Blanchard Hervé , Venier Anne-Gaëlle , Bernet Claude , Simon Loïc , Sénéchal Hélène , Pouchol Elodie , Angot Christiane , Ribaud Patricia , Socié G. , Flèche M. , Brieu Nathalie , Lagier Evelyne , Chartier Vanessa , Allegre Thierry , Maulin Laurence , Lanic Hélène , Tilly Hervé , Bouchara Jean-Philippe , Pihet Marc , Schmidt Aline , Kouatchet Achille , Vandamme Yves-Marie , Ifrah Norbert , Mercat Alain , Accoceberry Isabelle , Albert Olivier , Leguay Thibaut , Rogues Anne-Marie , Bonhomme Julie , Reman Oumédaly , Lesteven Claire , Poirier Philippe , Chabrot Cécile Molucon , Calvet Laure , Baud Olivier , Cambon Monique , Farkas Jean Chistophe , Lafon Bruno , Dalle Frédéric , Caillot Denis , Lazzarotti Aline , Aho Serge , Combret Sandrine , Facon Thierry , Sendid Boualem , Loridant Séverine , Louis Terriou , Cazin Bruno , Grandbastien Bruno , Bourgeois Nathalie , Lotthé Anne , Cartron Guillaume , Ravel Christophe , Colson Pascal , Gaudard Philippe , Bonmati Caroline , Simon Loic , Rabaud Christian , Machouart Marie , Poisson Didier , Carp Diana , Meunier Jérôme , Gaschet Anne , Miquel Chantal , Sanhes Laurence , Ferreyra Milagros , Leibinger Franck , Geudet Philippe , Toubas Dominique , Himberlin Chantal , Bureau-Chalot Florence , Delmer Alain , Favennec Loïc , Gargala Gilles , Michot Jean-Baptiste , Girault Christophe , David Marion , Leprêtre Stéphane , Jardin Fabrice , Honderlick Pierre , Caille Vincent , Cerf Charles , Cassaing Sophie , Recher Christian , Picard Muriel , Protin Caroline , Huguet Françoise , Huynh Anne , Ruiz Jean , Riu-Poulenc Béatrice , Letocart Philippe , Marchou Bruno , Verdeil Xavier , Cavalié Laurent , Chauvin Pamela , Iriart Xavier , Valentin Alexis , Bouvet Emmanuelle , Delmas-Marsalet Béatrice , Jeblaoui Asma , Kassis-Chikhani Najiby , Mühlethaler Konrad , Zimmerli Stefan , Zalar Polona , Sánchez-Reus Ferran , Gurgui Merce 
Published: December 2014

Rapidly 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.

IMPORTANCE
Several 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.