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Nosocomial Outbreak of Systemic Candidosis Associated With Parenteral Nutrition

Published online by Cambridge University Press:  21 June 2016

Maria Luisa Moro ,
Claudio Maffei ,
Esther Manso ,
Giulia Morace ,
Luciano Polonelli  and
Francesca Biavasco
Maria Luisa Moro*
Affiliation:
Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità Rome, Italy
Claudio Maffei
Affiliation:
Zstituto di Igiene, Università di Ancona
Esther Manso
Affiliation:
Zstituto di Igiene, Università di Ancona
Giulia Morace
Affiliation:
Zstituto di Microbiologia, Università Cattolica del Sacro Cuorer, Rome
Luciano Polonelli
Affiliation:
Zstituto di Microbiologia, Università Cattolica del Sacro Cuorer, Rome
Francesca Biavasco
Affiliation:
Istituto di Microbiologia, Universita di Ancona
*
Laboratorio di Epidemologia e Biostatistica, Istituto Superiors di Sanita, Viale Regina Elena, 299, 00161 Rome, Italy
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Abstract

Eight patients in two surgical units developed systemic candidosis during a 40-day period from June 5 to July 13, 1987 (in five cases Candida albicans was identified). Three of them died. All cases belonged to a group of 27 patients receiving parenteral nutrition (PN), while among the 108 patients who did not receive PN, no cases were observed (p = .000001). Candida was cultured from two PN bags administered to the cases. A specialized nutrition nurse was responsible for the PN compounding and for maintaining administration sets in the two wards involved.

An epidemiological investigation in which 19 uninfected patients who had had PN were used as controls, showed no significant difference between cases and controls except that lipids were more frequently added to bags administered to cases (p = .0005). Furthermore, the bags administered to cases contained a higher average number of multidose constituents (p = .0008) when the comparison was focused on the two days before the onset of symptoms.Given the favorable medium provided by lipids, even a low level contamination of PN solutions during compounding and/or administration could have been responsible for the outbreak. The finding of a more frequent exposure of cases to multidose vials suggests, although not conclusively, that an extrinsic contamination occurred during compounding. Six isolates of C albicans were available from four cases. C albicans was cultured from the pharyngeal swabs of two physicians and three nurses, including the specialized nutrition nurse. According to DNA restriction pattern analysis, a single strain was responsible for all the cases of systemic candidosis, with only the specialized nutrition nurse harboring the same strain. DNA fingerprinting provided a reliable system for typing C albicans strains. This was the first outbreak of C albicans systemic infection associated with PN.

Type
Original articles
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 1 , January 1990 , pp. 27 - 35
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

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