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December 1977

Nosocomial Outbreak of Candida parapsilosis Fungemia Related to Intravenous Infusions

Author Affiliations

From the Division of Infectious Diseases, Department of Internal Medicine (Drs Plouffe, Silva, Ms Stricof, and Fekety), and the Department of Environmental Health and Safety (Dr Brown), and Inpatient Pharmacy Service (Mr Eck) University of Michigan Medical Center, Ann Arbor. Dr Plouffe is now with the Division of Infectious Diseases, Department of Internal Medicine, Ohio State University, Columbus.

Arch Intern Med. 1977;137(12):1686-1689. doi:10.1001/archinte.1977.03630240022010

Candida parapsilosis is rarely isolated from blood cultures. Our hospital surveillance detected an increased rate of isolation of C parapsilosis during a fourmonth period. Fourteen postoperative patients receiving intravenous (IV) hyperalimentation and eight burn patients receiving IV albumin were involved. Hectic fever, the major clinical manifestation, was seen in 61% of cases. Therapy in the postoperative patients consisted merely of discontinuing IV catheters and hyperalimentation, while amphotericin B was needed in five of eight burn patients to control persistent fungemia.

Epidemiologic analysis identified a source of the organism in the IV-additive preparation room, where C parapsilosis was found contaminating a vacuum system. Organisms apparently refluxed into IV bottles when aliquots were removed to accommodate additives. Of 103 patients who received fluids prepared with the contaminated system, 21% became infected with C parapsilosis.

Infection surveillance was instrumental in detection and control of the outbreak. Routine guidelines should be established to insure the sterility of IV fluids containing additives.

(Arch Intern Med 137:1686-1689, 1977)