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Published on: January 27, 2015
Postsurgical Candida albicans infections associated with an extrinsically contaminated intravenous anesthetic agent
M M McNeil1, B A Lasker, T J Lott
1Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.mmm2@cdc.gov
Abstract:
From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hospital developed Candida albicans fungemia or endophthalmitis. The case patients' surgeries were clustered on two days. To identify risk factors for C. albicans infections, we conducted a cohort study comparing these 4 patients with 67 control patients who had surgeries on the same days but did not acquire C. albicans infections. The participation of anesthesiologist 9 (relative risk [RR], undefined; P < 0.001) and receipt of intravenous propofol, an anesthetic agent without preservative, which was administered by an infusion pump (RR, 8.8; P = 0.048) were identified as risk factors for C. albicans infections. The anesthetic had been recently introduced in the hospital. Hand cultures of 8 of 14 (57%) anesthesiologists were positive for Candida species; one yielded C. albicans. Anesthesiologist 9 was the only one to use stored syringes of propofol in the infusion pump and to reuse propofol syringes. DNA fingerprinting with a digoxigenin-labeled C. albicans repetitive element 2 probe and electrophoretic karyotyping showed two distinct banding patterns among patient isolates. We hypothesize that extrinsic contamination of propofol by anesthesiologist 9 likely resulted in C. albicans infections. These data suggest that strict aseptic techniques must be used when preparing and administering propofol.
Insights
Anesthesiologist contamination of propofol caused Candida albicans infections in postsurgical patients. Strict aseptic techniques are crucial when preparing and administering this anesthetic agent.
Area of Science:
- Infectious Diseases
- Anesthesiology
- Hospital Epidemiology
Background:
- A cluster of Candida albicans infections (fungemia and endophthalmitis) occurred in postsurgical patients.
- The infections were linked to surgeries performed on specific days, suggesting a common source or risk factor.
Purpose of the Study:
- To identify risk factors associated with Candida albicans infections in postsurgical patients.
- To investigate the potential role of anesthetic agents and personnel in the outbreak.
Main Methods:
- A cohort study compared 4 infected patients with 67 uninfected controls who underwent surgery on the same days.
- Risk factors, including anesthesiologist participation and anesthetic agent administration, were analyzed.
- Microbial cultures and DNA fingerprinting were used to identify the source and strain of Candida albicans.
Main Results:
- Anesthesiologist involvement and the use of intravenous propofol administered via infusion pump were identified as significant risk factors.
- Candida species were found on the hands of 57% of anesthesiologists, with one yielding Candida albicans.
- DNA fingerprinting revealed distinct patterns, supporting extrinsic contamination of propofol by a specific anesthesiologist.
Conclusions:
- Extrinsic contamination of propofol by an anesthesiologist likely caused the Candida albicans infections.
- Strict aseptic techniques are essential during the preparation and administration of propofol to prevent healthcare-associated infections.
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