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Nosocomial outbreak of systemic candidosis associated with parenteral nutrition
1Laboratorio di Epidemiologia e Biostatistica, Istituto Superiore di Sanità, Rome, Italy.
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 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.
Insights
Parenteral nutrition (PN) significantly increased the risk of systemic candidosis in surgical patients. Contamination of PN solutions, potentially during compounding, is suspected as the cause of this serious fungal infection.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Systemic candidosis is a serious opportunistic infection.
- Parenteral nutrition (PN) is a life-sustaining treatment for patients unable to consume food orally.
- The risk factors for PN-associated candidosis require thorough investigation.
Purpose of the Study:
- To investigate an outbreak of systemic candidosis in surgical patients.
- To identify the source and transmission route of the fungal infection.
- To determine the association between parenteral nutrition and candidosis.
Main Methods:
- An epidemiological investigation was conducted during an outbreak.
- Case-control study comparing patients with and without candidosis.
- Microbiological cultures of PN bags and personnel swabs were performed.
Main Results:
- Eight cases of systemic candidosis occurred in 27 patients receiving PN; no cases occurred in 108 patients not receiving PN (p = .000001).
- Candida was isolated from two PN bags used by affected patients.
- PN bags administered to cases had more frequent lipid additions and a higher number of multidose constituents.
Conclusions:
- Parenteral nutrition is a significant risk factor for systemic candidosis in surgical units.
- Extrinsic contamination of PN solutions during compounding or administration is the likely cause.
- Enhanced protocols for PN preparation and handling are crucial to prevent such infections.