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467 Candida invasive disease outbreak related with administration of propofol in an endoscopy digestive ward

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Cesar Villanueva, MD , University General Hospital of Alicante, Alicante, Spain
Gonzalez Torga Antonio, MD , University General Hospital of Alicante, Alicante, Spain
Martinez Hector Rolando, MD , University General Hospital of Alicante, Alicante, Spain
Camargo Angeles Robert, MD , University General Hospital of Alicante, Alicante, Spain
Casellas J. Antonio, MD , University General Hospital of Alicante, Alicante, Spain
Merino Esperanza, MD , University General Hospital of Alicante, Alicante, Spain
Portilla Joaquin, MD , University General Hospital of Alicante, Alicante, Spain
Sanchez Paya Jose, MD , University General Hospital of Alicante, Alicante, Spain
Background: In June 2010 four cases were reported of suspected infection likely associated with gastrointestinal endoscopy in a tertiary hospital in Alicante, Spain.

Objective: To describe an outbreak of C. albicans  in an endoscopy ward, and the associated factors.

Methods: We conducted an active search for cases among those patients who underwent endoscopy in room 1 of this unit, there were various laboratory tests and reviewed the recommendations, practices and procedures for the prevention of infections. We performed a retrospective cohort study to identify risk factors and/or associated. Case is defined as the onset of fever (temperature above 38ºC) within 24 hours after endoscopy.

Results: We identified 38 patients who were under any endoscopic procedure between 07/06/10 and 06/15/10, there were 27 possible cases, of these, 10 cases of folliculitis and skin nodules and 13 cases of endophthalmitis .Candida albicans was isolated in blood cultures from 2 patients and in cultured biopsies from 3 patients. C. albicans was isolated from an environmental sample. The variables studied were: = <60 years 71.4% (15/21) vs >60 years 70.6% (12/17) p=NS; Sex: Male 75.0% (18/24) vs Women  64,3% (9/14) p=NS; ASA: 2-3 67.9% (19/28) vs 1 80.0% (8/10) p=NS; Origin: Hospitalized 88.2% (15/17) vs  Outpatient 57.1% (12/21) p=0.07; Order realization: 1st-2nd-3rd 80,0% (16/20) vs Rest 61.1% (11/18) p= 0.20; Sedation: Yes 75.0% (27/36) vs No 0.0% (0/2) p=0.07; Propofol dose: >200 mg 83.3% (10/12) vs <= 200 mg 65.4% (17/26) p=0.26; Procedure: Echoendoscopy 75.0% (15/20) vs  Other 66.7% (12/18) p=NS; biopsy or other procedures: Yes 62.5% (5/8) vs No 73.3% (22/30) p=NS; Results: Pathological 69.6% (16/23) vs Normal/Other 73.3% (11/15) p=NS. All affected patients received propofol inappropriately using a single-patient-use vial of propofol for multiple patients.

Conclusions: The clinical and epidemiological data and the factors associated to infection that are at the limit of statistical significance (Origin: hospitalized, order realization: 1st-2nd-3rd, sedation and dose >200 mg) aimed that the most probable mechanism of transmission has been intravenous propofol probably contaminated during handling. Although there are described multiple cases of blood-borne virus outbreaks, cases of outbreaks of candida associated with the administration of anesthesia are rarely.