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Publications

Journal Article Multicenter Study Ppublish

PubMed: 42725369 DOI: 10.2807/1560-7917.ES.2026.31.36.2600311

Multicentre outbreak of Candida viswanathii bloodstream infections linked to contaminated milrinone, Italy, April to October 2025.

Euro Surveill 31(36)

Authors: Alessio Mesini, Giuseppe Spiga, Marta Ciofi Degli Atti, Debora Contu, Carmen D'Amore, Elisabetta Ugolotti, Gianluca Vrenna, Marco Castignone, Venere Cortazzo, Marco Merli, Lara Ricotta, Elisa Matarazzo, Elena De Carolis, Elisa De Pasqual, Maurizio Sanguinetti, Chiara Vismara, Paola Bernaschi, Anna Marchese, Roberto Bandettini, Carlo Federico Perno, Raffaele Spiazzi, Massimiliano Raponi, Elio Castagnola, Vincenzo Di Pilato

Affiliations

  • Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  • Clinical Governance Unit, Health Management Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  • Epidemiology, Clinical Pathways and Clinical Risk Unit, Medical Direction, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
  • Laboratory of Microbiology, IRCCS Istituto Giannina Gaslini, Genova, Italy.
  • Microbiology and Diagnostic Immunology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
  • Pharmacy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  • Division of Infectious Diseases, ASST Grande Ospedale, Milan, Italy.
  • Complex Unit of Clinical Microbiology. Department of Laboratories, Azienda Socio-Sanitaria Territoriale (ASST) Grande Ospedale Metropolitano (GOM) Niguarda, Milan, Italy.
  • Dipartimento di Scienze di Laboratorio ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • SC Farmacia, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
  • UO Microbiologia, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy.
  • Medical Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
  • Medical Direction, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.

Abstract

In 2025, a multicentre outbreak of bloodstream infections caused by Candida viswanathii, a rare non-albicans Candida species, was identified in Italy. The source was recognised after four C. viswanathii bloodstream infections were identified within a short period at a single centre. Initial local investigations did not identify environmental or patient-to-patient transmission. Given the strong geographical association of C. viswanathii with the Indian subcontinent, a hypothesis-driven investigation focusing on medicinal products of Indian origin was undertaken. Milrinone was the only common exposure among affected patients, and culture of the implicated product yielded C. viswanathii, confirming contamination. In total, 40 cases of C. viswanathii candidaemia were identified across four centres between April and October 2025; all were bloodstream infections. Most were associated with one predominant milrinone lot, although additional lots were implicated. Immediate control measures included withdrawal of the implicated product, notification of national authorities and active microbiological surveillance of exposed patients. This outbreak highlights the importance of clinician-led outbreak detection, hypothesis-driven epidemiology and pharmacovigilance in identifying rare, medicine-associated fungal infections.

MeSH

Milrinone, Sepsis, Communicable Diseases, Candida, Infections