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Journal of Clinical Microbiology, March 2007, p. 942-947, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01878-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Evidence for a Pseudo-Outbreak of Candida guilliermondii Fungemia in a University Hospital in Brazil{triangledown}

Eduardo Alexandrino Servolo Medeiros,1* Timothy J. Lott,2 Arnaldo Lopes Colombo,3 Patrício Godoy,3 Ana Paula Coutinho,1 Monica Santos Braga,1 Marcio Nucci,4 and Mary E. Brandt2

Hospital Infection Program, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil,1 Mycotic Diseases Branch, Division of Foodborne, Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333,2 Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil,3 Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil4

Received 9 September 2006/ Returned for modification 7 November 2006/ Accepted 1 January 2007

Fungal infections due to Candida species represent an important cause of nosocomial bloodstream infections. We report a large pseudo-outbreak of Candida guilliermondii fungemia that occurred in a university hospital in Brazil. C. guilliermondii was identified in 64 (43%) of the 149 blood samples drawn between June 2003 and July 2004. The samples were from patients in different wards of the hospital but concentrated in pediatric units. None of the patients had clinical signs of fungemia, and observational analysis revealed errors in the collection of blood samples. During the investigation of the pseudo-outbreak, C. guilliermondii was isolated from environmental surfaces and from the skin and nails of members of the nursing team. Through a subtyping analysis it was found that some of the nonpatient isolates were highly related to the patient isolates, and all the patient isolates were highly related. This is consistent with the hypothesis that the pseudo-outbreak was from a limited number of common sources. The adoption of intervention measures was effective in resolving the outbreak, supporting the hypothesis that the outbreak was due to poor techniques of drawing blood samples for culture.

* Corresponding author. Mailing address: Hospital Infection Program, Division of Infectious Diseases, Federal University of São Paulo, Rua Napoleao de Barros, 690, Segundo Andar, São Paulo, Brazil 04024002. Phone or fax: (5511) 5571-8935. E-mail: edubala{at}netpoint.com.br.

{triangledown} Published ahead of print on 17 January 2007.

Journal of Clinical Microbiology, March 2007, p. 942-947, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01878-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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