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Pseudoepidemic of urinary tract infections due to Trichosporon beigelii
1Department of Medicine, Memorial Hospital and Medical Center, Cumberland, Maryland 21502.
Abstract:
During the period April, 1985 to March, 1986, Trichosporon beigelii was isolated from the urine of 15 intensive care unit patients. All of these patients had Foley catheters in place at the time of T beigelii isolation. None of them had urinary tract infections on admission, and it was initially felt that this organism was a source of infection in these critically ill individuals. Subsequent investigation revealed this to be a pseudoepidemic secondary to contamination of the urinary catheter drainage system. Urine obtained by gravity drainage from the outlet port of urimeters yielded growth of T beigelii, whereas urines obtained concurrently from the proximal tubing sampling port were negative. T beigelii was isolated from the drainage port as well as from various items used in the collection and sampling of urine specimens. It is felt that these items were the source of perpetuation of this pseudoepidemic due to the repeated contamination and colonization of the distal portion of the urine catheter collection system. In-services to nursing and housekeeping personnel in the proper collection of urine specimens and cleaning of potentially contaminated items, the replacement of metal urine graduates with disposable plastic ones and increased monitoring of personnel's activities stopped the outbreak abruptly.
Insights
A Trichosporon beigelii pseudoepidemic in intensive care units was caused by contaminated urinary catheter drainage systems. Improved hygiene and disposable equipment successfully halted the outbreak, highlighting the importance of proper specimen collection protocols.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Intensive Care Medicine
Background:
- Trichosporon beigelii is a fungus that can cause opportunistic infections.
- Urinary tract infections are common in intensive care unit (ICU) patients, particularly those with Foley catheters.
- Initial isolation of T. beigelii from ICU patients' urine suggested a potential infection outbreak.
Purpose of the Study:
- To investigate the source of Trichosporon beigelii isolation in ICU patients.
- To determine if T. beigelii represented a true infection or a contamination event.
- To identify and implement control measures for the pseudoepidemic.
Main Methods:
- Microbiological analysis of urine samples from ICU patients with Foley catheters.
- Comparison of urine samples collected from different ports of the catheter drainage system.
- Environmental sampling of collection and sampling supplies.
- Implementation of enhanced hygiene protocols and equipment changes.
Main Results:
- Trichosporon beigelii was isolated from 15 ICU patients with Foley catheters over a 12-month period.
- T. beigelii was consistently isolated from the gravity drainage port but not the proximal sampling port, indicating contamination.
- The fungus was also found on various items used for urine collection and sampling.
- Implementing improved hygiene, staff training, and disposable collection equipment eradicated the pseudoepidemic.
Conclusions:
- The observed isolation of Trichosporon beigelii represented a pseudoepidemic due to contamination of the urinary catheter drainage system, not true patient infection.
- Contamination originated from the urine collection and sampling process.
- Enhanced infection control measures, including staff education and use of disposable supplies, were effective in resolving the pseudoepidemic.