Kuehnert M J, Clark E, Lockhart S R, Soll D R, Chia J, Jarvis W R
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Clin Infect Dis. 1998 Oct;27(4):688-91. doi: 10.1086/514944.
A patient developed Candida albicans endocarditis and fungemia after undergoing aortic valve replacement with an allograft. The allograft had been found during tissue bank processing to be contaminated with C. albicans, but it was culture-negative for C. albicans after routine disinfection with an antifungal-containing antimicrobial solution. Comparison of the preimplantation and postimplantation C. albicans isolates revealed remarkable genetic similarity, but antifungal susceptibility testing showed that the postimplantation isolate was more resistant to fluconazole and amphotericin B than the preimplantation isolate, suggesting emergence of resistance after disinfection. Implantation of a contaminated heart valve allograft can occur despite disinfection during processing and can result in endocarditis in the recipient. Antimicrobial disinfection protocols that include antifungal drugs may be ineffective. Current U.S. Food and Drug Administration regulations do not require companies to specify details concerning allograft processing. Additional measures may be required to prevent tissue bank release of allografts contaminated with C. albicans or other pathogens.
一名患者在接受同种异体主动脉瓣置换术后发生了白色念珠菌性心内膜炎和真菌血症。在组织库处理过程中发现该同种异体移植物被白色念珠菌污染，但在用含抗真菌药物的抗菌溶液进行常规消毒后，其白色念珠菌培养呈阴性。植入前和植入后白色念珠菌分离株的比较显示出显著的基因相似性，但抗真菌药敏试验表明，植入后的分离株比植入前的分离株对氟康唑和两性霉素B更耐药，提示消毒后出现了耐药性。尽管在处理过程中进行了消毒，但植入受污染的心脏瓣膜同种异体移植物仍可能发生，并可导致接受者发生心内膜炎。包括抗真菌药物在内的抗菌消毒方案可能无效。美国食品药品监督管理局目前的规定不要求公司详细说明同种异体移植物处理的细节。可能需要采取额外措施以防止组织库放行被白色念珠菌或其他病原体污染的同种异体移植物。
