1019Bipolaris Surgical Site Infections among Cardiothoracic Surgery Patients —Texas, Arkansas, and Florida, 2008–2013
Year: 2014
Type: conference-abstract
Abstract: Background. The environmental mold Bipolaris causes sinusitis or skin infection; surgical site infections (SSI) are extremely rare. In November 2013, state officials were alerted to seven Bipolaris cardiothoracic SSIs, with five deaths, occurring since May 2013 at three Texas and Arkansas hospitals. We conducted an investigation to describe this cluster and identify possible sources. Methods. Cases were defined as Bipolaris spp. isolated from a sterile site during 2008–2013 in patients with prior cardiothoracic surgery. Nationwide case-finding was conducted through state infection control alerts and listservs, such as ClinMicroNet. We abstracted clinical and medication/product information from medical records and reviewed microbiology records. Environmental sampling was conducted at five hospitals. Multi-locus sequence typing (MLST) was performed on case-patient and environmental isolates. Results. We identified 21 case-patients at 10 hospitals in Texas, Arkansas, and Florida; 11 (52%) occurred in 2013. Median case-patient age was 55 years (range: 3 days–82 years), and 19 (90%) were male. Nine (43%) had coronary artery bypass (CABG) or valve surgery, seven (33%) had heart transplant; 15 (71%) required more than one surgical procedure (median: 3, range: 1–11). Thirteen (62%) had delayed sternal closure with chest left open for a median of 8 days (range 2-22). Fifteen (71%) had mediastinitis, and 16 (76%) died. No common compounded or commercial products administered primarily to case-patients were identified. MLST showed substantial variation among clinical and environmental isolates. Microbiology records indicated an overall increase in Bipolaris isolates, particularly from non-sterile sites, during 2000–2013 at multiple hospitals in the region, including those without cases. Conclusion. Bipolaris SSI occurred in children and adults undergoing different types of cardiac surgeries, especially those with multiple surgeries and delayed sternal closure. Epidemiological and microbiologic evidence does not support a common product exposure. Bipolaris may be an emerging cause of infection in the southern United States; surgeons and infection control staff should be aware of this infection and have a low threshold to culture for mold. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Authors: Anne Purfield, Snigdha Vallabhaneni, Kaitlin Benedict, Shawn Lockhart, Cau Pham, Ulzii Luvsansharav, Wendy Chung, Emily Hall, Jordan Peart, Neil Pascoe, Gary Heseltine, Charlotte Wheeler, Karen Brust, Sharon Holmes, Prinu Gabriel, Justin Groves, Craig Gilliam, Christi Zumwalt, Doramarie Arocha, Russ Jones, D Haselow, Laura Lester, Kelley Garner, J. Gary Wheeler, Sekai Chideya, Alison S. Laufer, Benjamin Park
Institutions: Centers for Disease Control and Prevention, Epidemic Intelligence Service, Dallas County, Texas Department of State Health Services, Scott & White Memorial Hospital, Baylor Scott & White Medical Center - Temple, Children's Medical Center, Texas Health Harris Methodist Hospital Fort Worth, Arkansas Children's Hospital, Medical City Dallas Hospital, Medical City Children's Hospital, The University of Texas Southwestern Medical Center, Arkansas Department of Health
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W1901674366