title: High rate of candidemia in patients sustaining injuries in a bomb blast at a marketplace: a possible environmental source.
abstract: In this study, a cluster of candidemia among patients sustaining injuries in a bomb blast at a marketplace was investigated by means of a multivariate analysis, a case-control study, and quantitative air sampling. Candidemia occurred in 7 (30%) of 21 patients (58% of those admitted to the intensive care unit [ICU]) between 4 and 16 days (mean, 12 days) after the injury and was the single most frequent cause of bloodstream infections. Inhalation injury was the strongest predictor for candidemia by multivariate analysis. Candidemia among the case patients occurred at a significantly higher rate than among comparable trauma patients injured in different urban settings, including a pedestrian mall (2 of 29; P=. 02), and among contemporary ICU control patients (1 of 40; P=.001). Air sampling revealed exclusive detection of Candida species and increased mold concentration in the market in comparison with the mall environment. These findings suggest a role for an exogenous, environmental source in the development of candidemia in some trauma patients.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hadassah University Hospital, Jerusalem 91120, Israel. wolfd@md2.huji.ac.il
authors.forename: D G
authors.initials: DG
authors.lastname: Wolf
authors.forename: I
authors.initials: I
authors.lastname: Polacheck
authors.forename: C
authors.initials: C
authors.lastname: Block
authors.forename: C L
authors.initials: CL
authors.lastname: Sprung
authors.forename: M
authors.initials: M
authors.lastname: Muggia-Sullam
authors.forename: Y G
authors.initials: YG
authors.lastname: Wolf
authors.forename: A
authors.initials: A
authors.lastname: Oppenheim-Eden
authors.forename: A
authors.initials: A
authors.lastname: Rivkind
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001753:Blast Injuries / Q000150:complications*; D002175:Candida / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000209:etiology / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D004777:Environment; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D016469:Fungemia / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis