Epidemiologic and molecular characterization of an outbreak of Candida parapsilosis bloodstream infections in a community hospital
Epidemiologic and molecular characterization of an outbreak of Candida parapsilosis bloodstream infections in a community hospital
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DOI：
10.1128/jcm.42.10.4468-4472.2004
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发表时间：
2004-10-01
影响因子：
9.4
通讯作者：
Hajjeh, RA
中科院分区：
文献类型：
--
作者：
Clark, TA;Slavinski, SA;Hajjeh, RA
近平滑假丝酵母菌是卫生保健环境中血流感染的重要原因。我们调查了一个大的C。本研究以某社区医院发生的近平滑病暴发为研究对象，进行了病例对照研究，以确定感染的危险因素。我们发现22例血液感染的C。近平滑：15例确诊，7例可能。与感染风险增加相关的因素包括在重症监护室住院（校正比值比，16.4; 95%置信区间，1.8至148.1）和接受全肠外营养（校正比值比，9.2; 95%置信区间，0.9至98.1）。从医护人员的手、中心静脉导管插入部位和医疗器械中获取监测培养物样本。26%的被调查卫生保健工作者表现出手部C。用Cp 3 -13探针检测，1株手分离株与所有病例-患者分离株高度相关。暴发菌株分离株也表现出对氟康唑和伏立康唑的敏感性降低。这是已知最大的C。近平滑体病在成人中的血流感染是宿主、环境和病原体因素相互作用的结果。控制措施建议侧重于改善手部卫生依从性。
Candida parapsilosis is an important cause of bloodstream infections in the health care setting. We investigated a large C. parapsilosis outbreak occurring in a community hospital and conducted a case-control study to determine the risk factors for infection. We identified 22 cases of bloodstream infection with C. parapsilosis: 15 confirmed and 7 possible. The factors associated with an increased risk of infection included hospitalization in the intensive care unit (adjusted odds ratio, 16.4; 95% confidence interval, 1.8 to 148.1) and receipt of total parenteral nutrition (adjusted odds ratio, 9.2; 95% confidence interval, 0.9 to 98.1). Samples for surveillance cultures were obtained from health care worker hands, central venous catheter insertion sites, and medical devices. Twenty-six percent of the health care workers surveyed demonstrated hand colonization with C. parapsilosis, and one hand isolate was highly related to all case-patient isolates by tests with the DNA probe Cp3-13. Outbreak strain isolates also demonstrated reduced susceptibilities to fluconazole and voriconazole. This largest known reported outbreak of C. parapsilosis bloodstream infections in adults resulted from an interplay of host, environment, and pathogen factors. Recommendations for control measures focused on improving hand hygiene compliance.