Postsurgical Candida albicans infections associated with an extrinsically contaminated intravenous anesthetic agent

From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hos pital developed Candida albicans fungemia or endophthalmitis. The ease pati ents' surgeries were clustered on two days. To identify risk factors for C, albicans infections, we conducted a cohort studs comparing these 4 patient s with 67 control patients who had surgeries on the same days but did not a cquire C. albicans infections. The participation of anesthesiologist 9 (rel ative risk [RR], undefined; P < 0.001) and receipt of intravenous propofol, an anesthetic agent without preservative, which was administered by an inf usion pump (RR, 8.8: P = 0.048) were identified as risk factors for C, albi cans infections. The anesthetic had been recently introduced in the hospita l. Hand cultures of 8 of 14 (57%) anesthesiologists were positive for Candi da species; one yielded C, albicans, Anesthesiologist 9 was the only. one t o use stored syringes of propofol in the infusion pump and to reuse propofo l syringes. DNA fingerprinting with a digoxigenin-labeled C, albicans repet itive element 2 probe and electrophoretic karyotyping showed two distinct b anding patterns among patient isolates. We hypothesize that extrinsic conta mination of propofol by anesthesiologist 9 likely resulted in C, albicans i nfections. These data suggest that strict aseptic techniques must be used w hen preparing and administering propofol.