CANDIDA-ALBICANS ENDOCARDITIS ASSOCIATED WITH A CONTAMINATED AORTIC-VALVE ALLOGRAFT - IMPLICATIONS FOR REGULATION OF ALLOGRAFT PROCESSING

A patient developed Candida albicans endocarditis and fungemia after u ndergoing aortic valve replacement with an allograft. The allograft ha d been found during tissue bank processing to be contaminated with C. albicans, but it was culture-negative for C, albicans after routine di sinfection with an antifungal-containing antimicrobial solution. Compa rison of the preimplantation and postimplantation C, albicans isolates revealed remarkable genetic similarity, but antifungal susceptibility testing showed that the postimplantation isolate was more resistant t o fluconazole and amphotericin B than the preimplantation isolate, sug gesting emergence of resistance after disinfection, Implantation of a contaminated heart valve allograft can occur despite disinfection duri ng processing and can result in endocarditis in the recipient. Antimic robial disinfection protocols that include antifungal drugs may be ine ffective. Current U.S. Food and Drug Administration regulations do not require companies to specify details concerning allograft processing. Additional measures may be required to prevent tissue bank release of allografts contaminated with C. albicans or other pathogens.