High rate of candidemia in patients sustaining injuries in a bomb blast ata marketplace: A possible environmental source

In this study, a cluster of candidemia among patients sustaining injuries i n a bomb blast at a marketplace was investigated by means of a multivariate analysis, a case-control study, and quantitative air sampling, Candidemia occurred in 7 (30%) of 21 patients (58% of those admitted to the intensive care unit [ICU]) between 4 and 16 days (mean, 12 days) after the injury and was the single most frequent cause of bloodstream infections. Inhalation i njury was the strongest predictor for candidemia by multivariate analysis. Candidemia among the case patients occurred at a significantly higher rate than among comparable trauma patients injured in different urban settings, including a pedestrian mall (2 of 29; P = .02), and among contemporary ICU control patients (1 of 40; P = .001). Air sampling revealed exclusive detec tion of Candida species and increased mold concentration in the market in c omparison with the mall environment. These findings suggest a role for an e xogenous, environmental source in the development of candidemia in some tra uma patients.