title: Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse.
abstract: From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting > 165 min (11/15 vs. 20/45; odds ratio [OR], 5.0; 95% confidence interval [CI], 1.5-16.3) or exposure to first scrub nurse A (15/15 vs. 22/45; OR, infinity; 95% CI, 2.5, infinity). Molecular typing of 5 case-patient C. albicans isolates revealed a common strain. Nurse A had a history of recurrent vaginal infections responding to topical antifungal agents; however, cultures of multiple samples from nurse A, beginning 3 weeks after the last infected patient's surgery, failed to yield C. albicans. Following her voluntary transfer from cardiac surgery, no additional infections of case-patients were detected. This study demonstrates the utility of combining epidemiologic methods and molecular typing in investigating C. albicans infection clusters and suggests that a common exogenous source can be responsible for C. albicans surgical wound infections.
authors.affiliation: Division of Field Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Pertowski
authors.forename: R C
authors.initials: RC
authors.lastname: Baron
authors.forename: B A
authors.initials: BA
authors.lastname: Lasker
authors.forename: S B
authors.initials: SB
authors.lastname: Werner
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015139:Blotting, Southern; D002140:California; D002176:Candida albicans / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000635:transmission; D006348:Cardiac Surgical Procedures / Q000451:nursing*; D001026:Coronary Artery Bypass / Q000451:nursing*; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D004271:DNA, Fungal / Q000032:analysis / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009871:Operating Room Nursing; D012307:Risk Factors; D013249:Sternum / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000635:transmission
chemical_list: D004271:DNA, Fungal