Nosocomial Outbreak of Exophiala jeanselmei Fungemia Associated with Contamination of Hospital Water

From December 1996 through September 1997, we diagnosed 19 cases of fungemia due to Exophiala jeanselmei. We conducted a matched case-control study in which we cultured specimens of blood products, intravenous solutions, and water from a hospital water system. Isolates from environmental cultures we...

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Bibliographic Details
Published in:Clinical infectious diseases 2002-06, Vol.34 (11), p.1475-1480
Main Authors: Marcio, Nucci, Tiyomi, Akiti, Gloria, Barreiros, Fernanda, Silveira, Revankar, Sanjay G., Brian, L. Wickes, Sutton, Deanna A., Patterson, Thomas F.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Blood
Catheters
Cell Culture Techniques
Cross Infection - epidemiology
Cross Infection - microbiology
Disease Outbreaks
DNA, Fungal - analysis
Exophiala
Female
Fungemia
Fungemia - epidemiology
Fungemia - microbiology
Fungi
Hospitalization
Hospitals
Human mycoses
Humans
Infections
Infectious diseases
Major Articles
Male
Medical sciences
Middle Aged
Mycoses
Mycoses - epidemiology
Mycoses - microbiology
Mycotic sepsis
Pharmacies
Predisposing factors
Risk Factors
Water Microbiology
Water Pollution
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Summary:From December 1996 through September 1997, we diagnosed 19 cases of fungemia due to Exophiala jeanselmei. We conducted a matched case-control study in which we cultured specimens of blood products, intravenous solutions, and water from a hospital water system. Isolates from environmental cultures were compared to those recovered from patients by random amplification of polymorphic DNA (RAPD). Multivariate analysis showed that neutropenia, longer duration of hospitalization, and use of corticosteroids were risk factors for infection. Environmental cultures yielded E. jeanselmei from 3 of 85 sources: deionized water from the hospital pharmacy, 1 water tank, and water from a sink in a non-patient care area. Use of deionized pharmacy water to prepare antiseptic solutions was discontinued, and no additional cases of infection occurred. RAPD typing showed that isolates from case patients and isolates from the pharmacy water were highly related, whereas the patterns of isolates recovered from the 2 other sources of water were distinct.
ISSN:1058-4838
1537-6591
DOI:10.1086/340344