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Outbreak of Bloodstream Infection With the Mold Phialemonium Among Patients Receiving Dialysis at a Hemodialysis Unit

Published online by Cambridge University Press:  21 June 2016

Thomas Clark ,
Gregory D. Huhn ,
Craig Conover ,
Salvatore Cali ,
Matthew J. Arduino ,
Rana Hajjeh ,
Mary E. Brandt  and
Scott K. Fridkin
Thomas Clark
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Gregory D. Huhn
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Craig Conover
Affiliation:
Illinois Department of Public Health, Chicago, Illinois
Salvatore Cali
Affiliation:
Great Lakes Center of Excellence in Environmental Health, University of Illinois at Chicago, School of Public Health, Chicago, Illinois
Matthew J. Arduino
Affiliation:
Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Rana Hajjeh
Affiliation:
Divisions of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Mary E. Brandt
Affiliation:
Divisions of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Scott K. Fridkin*
Affiliation:
Divisions of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
MS C-09, Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, Georgia30333 (skf0@cdc.gov)
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Abstract

Background

Molds are a rare cause of disseminated infection among dialysis patients.

Objective.

We evaluated a cluster of intravascular infections with the mold Phialemonium among patients receiving hemodialysis at the same facility in order to identify possible environmental sources and prevent further infection.

Design.

Environmental assessment and case-control study.

Setting.

A hemodialysis center affiliated with a tertiary care hospital.

Methods.

We reviewed surveillance and clinical microbiology records and performed a blood culture survey for all patients. The following data for case patients were compared with those for control patients: underlying illness, dialysis characteristics, medications, and other possible exposure for 120 days prior to infection. Environmental assessment of water treatment, dialysis facilities, and heating, ventilation, and air-conditioning (HVAC) systems of the current and previous locations of the dialysis center was performed. Samples were cultured for fungus; Phialemonium isolates were confirmed by sequencing of DNA. Investigators observed dialysis access site disinfection technique.

Results.

Four patients were confirmed as case patients, defined as a patient having intravascular infection with Phialemonium species; 3 presented with fungemia, and 1 presented with an intravascular graft infection. All case patients used a fistula or graft for dialysis access, as did 12 (75%) of 16 of control patients (P = .54). Case and control patients did not differ in other dialysis characteristics, medications received, physiologic findings, or demographic factors. Phialemonium species were not recovered from samples of water or dialysis machines, but were recovered from the condensation drip pans under the blowers of the HVAC system that supplied air to the dialysis center. Observational study of 21 patients detected suboptimal contact time with antiseptic agents used to prepare dialysis access sites.

Conclusion.

The report of this outbreak adds to previous published reports of Phialemonium infection occurring in immunocompromised patients who likely acquired infection in the healthcare setting. Recovery of this mold from blood culture should be considered indicative of infection until proven otherwise. Furthermore, an investigation into possible healthcare-related environmental reservoirs should be considered.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1164 - 1170
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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