AN OUTBREAK OF CANDIDA-PARAPSILOSIS PROSTHETIC VALVE ENDOCARDITIS

Candida parapsilosis, an important nosocomial pathogen and the most co mmon species of Candida found on the hands of health care workers, is a rare cause of prosthetic valve endocarditis (PVE). From March throug h June 1994, four cases of C. parapsilosis PVE were diagnosed at a 400 -bed community hospital. The mean time to presentation after valve rep lacement surgery was 148 days (range, 20 to 345). Three of the four pa tients died of complications of PVE. Multiple environmental cultures w ere performed, and only one was positive for C. parapsilosis. Cultures from the bypass pump cell saver, cardioplegia solution, and subsequen t valves were all negative. All valve replacements were performed by t he same operating room team. Interviews with the surgeon and physician assistant, the only personnel involved in all cases, revealed that th eir hypoallergenic gloves were subject to frequent tears during valve replacement procedures, often requiring several glove changes per proc edure. Hand cultures of personnel were obtained, and cultures from 20 individuals (26%) were positive for C. parapsilosis. Hand cultures of the surgeon and physician assistant obtained 8 months after the last c ase had surgery were negative for yeasts. Molecular typing of the 3 av ailable case isolates, 14 epidemiologically unrelated patient isolates , 1 environmental isolate, and 20 hand isolates was performed by elect rophoretic karyotyping and restriction endonuclease analysis of genomi c DNA using restriction enzymes BssHII and EagI followed by pulsed fie ld gel electrophoresis. The three case isolates were identical by rest riction endonuclease analysis of genomic DNA, and two of the three sha red the same electrophoretic karyotyping profile. The remaining patien t, environmental, and hand isolates represented 29 different DNA types and were distinctly different from the case isolates. All of the isol ates tested were susceptible to amphotericin B, 5FC, fluconazole, and itraconazole. The circumstantial evidence suggests the probability of glove tears during valve replacement surgery and subsequent transmissi on of C. parapsilosis to patients. (C) 1997 Elsevier Science Inc.