Epidemiologic and molecular characterization of an outbreak of Candida parapsilosis bloodstream infections in a community hospital.
Candida parapsilosis is an important cause of bloodstream infections in the health care setting. We investigated a large C. parapsilosis outbreak occurring in a community hospital and conducted a case-control study to determine the risk factors for infection. We identified 22 cases of bloodstream infection with C. parapsilosis: 15 confirmed and 7 possible. The factors associated with an increased risk of infection included hospitalization in the intensive care unit (adjusted odds ratio, 16.4; 95% confidence interval, 1.8 to 148.1) and receipt of total parenteral nutrition (adjusted odds ratio, 9.2; 95% confidence interval, 0.9 to 98.1). Samples for surveillance cultures were obtained from health care worker hands, central venous catheter insertion sites, and medical devices. Twenty-six percent of the health care workers surveyed demonstrated hand colonization with C. parapsilosis, and one hand isolate was highly related to all case-patient isolates by tests with the DNA probe Cp3-13. Outbreak strain isolates also demonstrated reduced susceptibilities to fluconazole and voriconazole. This largest known reported outbreak of C. parapsilosis bloodstream infections in adults resulted from an interplay of host, environment, and pathogen factors. Recommendations for control measures focused on improving hand hygiene compliance.
Clark
Thomas A
TA
Epidemic Intelligence Service, Epidemiology Program Office, Division of Applied Public Health Training, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. tnc4@cdc.gov
Slavinski
Sally A
SA
Morgan
Juliette
J
Lott
Timothy
T
Arthington-Skaggs
Beth A
BA
Brandt
Mary E
ME
Webb
Risa M
RM
Currier
Mary
M
Flowers
Richard H
RH
Fridkin
Scott K
SK
Hajjeh
Rana A
RA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002175:Candida / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology*; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors