Rao Carol Y, Pachucki Constance, Cali Salvatore, Santhiraj Mangai, Krankoski Kathi L K, Noble-Wang Judith A, Leehey David, Popli Subhash, Brandt Mary E, Lindsley Mark D, Fridkin Scott K, Arduino Matthew J
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Infect Control Hosp Epidemiol. 2009 Sep;30(9):840-7. doi: 10.1086/605324.
We investigated a cluster of cases of bloodstream infection (BSI) due to the mold Phialemonium at a hemodialysis center in Illinois and conducted a cohort study to identify risk factors.
Environmental assessment and cohort study.
A hemodialysis center in a tertiary care hospital.
A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive for Phialemonium curvatum on culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA.
We identified 2 case patients with BSI due to P. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolated P. curvatum from the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station.
The source of P. curvatum was likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due to P. curvatum may be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient's blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility.
我们对伊利诺伊州一家血液透析中心发生的由瓶梗霉引起的一系列血流感染（BSI）病例进行了调查，并开展了一项队列研究以确定风险因素。
环境评估和队列研究。
一家三级护理医院的血液透析中心。
病例患者定义为在该中心接受透析且血液样本经培养检测出弯孢瓶梗霉呈阳性的人。我们查阅了微生物学和医疗记录，并通过培养对水、表面和透析液样本进行检测。从环境和临床标本中分离出的霉菌通过其形态特征进行鉴定，并通过DNA测序加以确认。
我们确定了2例由弯孢瓶梗霉引起的BSI病例。两人在同一治疗站的同一台机器上进行透析时均出现发热和低血压症状，不过是在不同日期。透析机配备了用于丢弃透析器预充液的废物处理选装端口。我们在19个治疗站中的2个站的产水（即用于透析目的的水）中分离出了弯孢瓶梗霉，其中一个站就是涉及的站点。
弯孢瓶梗霉的来源可能是水分配系统。据我们所知，这是首例患者因受污染的产水而感染霉菌BSI的报告。在这些由弯孢瓶梗霉引起的BSI病例中，暴露途径可能与废物处理选装端口的故障和维护不当有关。废物处理选装端口此前曾被认为是细菌BSI的来源，原因是废液回流到患者的血路中。在对水分配系统进行修复并停止使用该设施的废物处理选装端口后，未发现其他感染病例。
