title: Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.
abstract: Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to Candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.
authors.affiliation: The Stamford Hospital, Stamford, CT, and Columbia University College of Physicians and Surgeons, NY, USA. michael_parry@stamhosp.chime.org
authors.forename: M F
authors.initials: MF
authors.lastname: Parry
authors.forename: B
authors.initials: B
authors.lastname: Grant
authors.forename: M
authors.initials: M
authors.lastname: Yukna
authors.forename: D
authors.initials: D
authors.lastname: Adler-Klein
authors.forename: G X
authors.initials: GX
authors.lastname: McLeod
authors.forename: R
authors.initials: R
authors.lastname: Taddonio
authors.forename: C
authors.initials: C
authors.lastname: Rosenstein
mesh_terms: D000328:Adult; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000209:etiology* / Q000382:microbiology / Q000635:transmission; D016022:Case-Control Studies; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology / Q000635:transmission; D015299:Discitis / Q000209:etiology* / Q000382:microbiology; D017586:Diskectomy / Q000009:adverse effects; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006282:Health Personnel; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient; D007796:Laminectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000382:microbiology*; D010019:Osteomyelitis / Q000209:etiology* / Q000382:microbiology; D019736:Prostheses and Implants / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D013997:Time Factors