NOCARDIA FARCINICA STERNOTOMY SITE INFECTIONS IN PATIENTS FOLLOWING OPEN-HEART-SURGERY

Although Nocardia farcinica surgical site infection outbreaks have bee n reported (though rarely), no source for these has been identified. F rom May 1992 through June 1993, 5 patients contracted N. farcinica ste rnotomy site infections following open heart surgery at hospital A, A case-control study comparing case-patients (n = 5) with open heart sur gery patients without subsequent sternotomy site infections (n = 50) i dentified as risk factors diabetes (4/5 vs. 11/50, P < .02) and exposu re to a particular anesthesiologist (anesthesiologist A; 4/5 vs. 9/50, P < .01), Four case-patients' isolates and a hand isolate of anesthes iologist A had an identical ribotype pattern (strain 1); the remaining case-patient's isolate and multiple isolates from anesthesiologist A' s hands and home had a different ribotype pattern (strain 2), An inten sified hand-washing regimen, barriers (gloves, gowns), and cleaning of anesthesiologist A's house were associated with termination of the ou tbreak. This is the first reported nosocomial N. farcinica outbreak to document the source and person-to-person transmission epidemiological ly and molecularly.