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December 1977

Nosocomial Outbreak of Candida parapsilosis Fungemia Related to Intravenous Infusions

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)