RESUMEN
OBJECTIVE: To determine the clinical significance and source of fungemia following a cluster of positive blood cultures during a 3-day period. DESIGN: Chart review was used to determine the clinical significance of positive blood cultures. Microbiologic sampling of the laboratory environment was used to determine potential sources of fungal contamination. SETTING: A large, tertiary care, community teaching hospital. PATIENTS: All patients with blood cultures positive for Aspergillus species, Penicillium species, or both during the outbreak period. RESULTS: Thirteen patients, all children, were reported to have positive blood cultures for fungus during a 3-day period in early 1990. None had clinical features consistent with fungemia. Investigation of specimen processing procedures revealed that microbiologic plates were not processed--as per protocol--under the biologic hood but inadvertently were left open to air on the work bench by laboratory technicians. Settling plates left at the workbench, at door entry sites, and at sites of renovation immediately adjacent to the laboratory were positive for Aspergillus and/or Penicillium; control plates placed elsewhere were negative. Airflow patterns suggested spread into the microbiologic laboratory through an open door located near the implicated workbench station and a false ceiling above the workbench area. CONCLUSIONS: Our investigation demonstrates that faulty technique in the laboratory coupled with a change in environmental conditions can result in false-positive cultures and an outbreak of pseudofungemia.
Asunto(s)
Aspergilosis/epidemiología , Brotes de Enfermedades , Fungemia/epidemiología , Arquitectura y Construcción de Hospitales , Aspergilosis/microbiología , Niño , Preescolar , Reacciones Falso Positivas , Fungemia/microbiología , Hospitales con más de 500 Camas , Hospitales Universitarios , Humanos , Lactante , Recién Nacido , Laboratorios de Hospital , Michigan , Micología/métodos , Penicillium/aislamiento & purificación , Agrupamiento Espacio-TemporalRESUMEN
OBJECTIVE: To assess the incidence and spectrum of complications associated with central venous catheter (CVC) placement in the critically ill infant. DESIGN: A prospective study of all babies hospitalized in a neonatal intensive care unit (NICU) from January 1989 to December 1989. Potential risk factors associated with infection were evaluated by a case-control comparison. SETTING: Conducted at a university-affiliated, tertiary care community hospital. PATIENTS: Neonates requiring intensive care and a central venous catheter. Controls consisted of noninfected babies. RESULTS: Of 263 critically ill neonates, only 13 (4.9%) required a CVC insertion. Seventeen CVCs were placed in these 13 neonates for a total duration of 600 days (median, 32 days/cannula). Fifteen (88%) of these cannulas had one or more complications during its catheter life including dislodgement or leakage (53%), occlusion or thrombosis (47%), infections (29%), or minor bleeding (12%). Five babies (29%) developed 6 episodes of bloodstream infection including 3 sporadic cases due to Staphylococcus epidermidis and a cluster of fungemia due to Malassezia furfur associated with lipid emulsion therapy. Infants with a CVC-associated infection were a younger gestational age (24 weeks versus 32 weeks, p = .04) and weighed less at birth (580 g versus 1285 g, p = .02). The overall rate of bloodstream infection was one episode per 100 days of catheter use. CONCLUSIONS: CVCs may be lifesaving to a critically ill neonate, but complications occur frequently. Use must be restricted to infants in whom alternate delivery routes of intravenous therapy or support are otherwise unavailable.