title: Evidence for a pseudo-outbreak of Candida guilliermondii fungemia in a university hospital in Brazil.
abstract: Fungal infections due to Candida species represent an important cause of nosocomial bloodstream infections. We report a large pseudo-outbreak of Candida guilliermondii fungemia that occurred in a university hospital in Brazil. C. guilliermondii was identified in 64 (43%) of the 149 blood samples drawn between June 2003 and July 2004. The samples were from patients in different wards of the hospital but concentrated in pediatric units. None of the patients had clinical signs of fungemia, and observational analysis revealed errors in the collection of blood samples. During the investigation of the pseudo-outbreak, C. guilliermondii was isolated from environmental surfaces and from the skin and nails of members of the nursing team. Through a subtyping analysis it was found that some of the nonpatient isolates were highly related to the patient isolates, and all the patient isolates were highly related. This is consistent with the hypothesis that the pseudo-outbreak was from a limited number of common sources. The adoption of intervention measures was effective in resolving the outbreak, supporting the hypothesis that the outbreak was due to poor techniques of drawing blood samples for culture.
authors.affiliation: Hospital Infection Program, Division of Infectious Diseases, Federal University of São Paulo, Rua Napoleao de Barros, 690, Segundo Andar, São Paulo, Brazil 04024002. edubala@netpoint.com.br
authors.forename: Eduardo Alexandrino Servolo
authors.initials: EA
authors.lastname: Medeiros
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Lott
authors.forename: Arnaldo Lopes
authors.initials: AL
authors.lastname: Colombo
authors.forename: Patrício
authors.initials: P
authors.lastname: Godoy
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Coutinho
authors.forename: Monica Santos
authors.initials: MS
authors.lastname: Braga
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Mary E
authors.initials: ME
authors.lastname: Brandt
mesh_terms: D001769:Blood / Q000382:microbiology; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D003470:Culture Media; D004196:Disease Outbreaks; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology*; D006785:Hospitals, University; D006801:Humans; D019105:Random Amplified Polymorphic DNA Technique
chemical_list: D003470:Culture Media