Nosocomial outbreak of Candida parapsilosis fungemia related to intravenous infusions

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Abstract
C. parapsilosis is rarely isolated from blood cultures. Hospital surveillance detected an increased rate of isolation of C. parapsilosis during a 4 mo. period. Fourteen postoperative patients receiving i.v. hyperalimentation and 8 burn patients receiving i.v. albumin were involved. Hectic fever, the major clinical manifestation, was seen in 61% of cases. Therapy in the postoperative patients consisted merely of discontinuing i.v. catheters and hyperalimentation, while amphotericin B was needed in 5 of 8 burn patients to control persistent fungemia. Epidemiologic analysis identified a source of the organism in the i.v.-additive preparation room, where C. parapsilosis was found contaminating a vacuum system. Organisms apparently refluxed into i.v. 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 i.v. fluids containing additives.

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