MYCOLOGY Candida parapsilosis Fungemia Associated with Implantable and Semi-Implantable Central Venous Catheters and the Hands of Healthcare Workers A. S. Levin, S. F. Costa, N. S. Mussi, M. Basso, S. I. Sinto, C. Machado, D. C. Geiger, M. C. B. Villares, A. Z. Schreiber, A. A. Barone, and M. L. M. Branchini A cluster of six cases of fungemia among hematology, bone marrow transplant, and oncology patients was investigated in a case-control study (18 controls). The use of implantable and semi-implantable central venous catheters was significantly associated with cases (p = 0.016). The hands of three health- care workers (HCWs) were positive for Candida parapsilo- sis. Electrophoretic karyotyping showed two profiles among patients and HCWs, and five among six unrelated strains. The profiles of two HCWs matched the ones of the patients they had handled. The patients’ strains were moderate or strong slime producers, whereas none of the HCWs’ were strong pro- ducers. In conclusion, our results indicated the occurrence of an outbreak C. parapsilosis fungemia related to long-term central venous catheters in which the hands of HCWs were implicated. The amount of slime production might be associ- ated with the pathogenicity of the strains. © 1998 Elsevier Science Inc. INTRODUCTION Candida species other than C. albicans have been growing in importance in many hospitals (Colombo et al. 1996; Still et al. 1995), especially among oncol- ogy and bone marrow transplant (BMT) patients (Cancelaz et al. 1994; Chao et al. 1994). In a recent literature review on Candida infections in oncology patients, Candida other than C. albicans accounted for 46% of all systemic Candida infections and C. parap- silosis for 7% (Wingard 1995). The epidemiology of nosocomial C. parapsilosis is still undefined and may involve sources such as hospital environment and hands of health care workers. Hospital acquisition of C. parapsilosis is associated with the contamination of parenteral nutrition, blood pressure transducers, ventriculoperitoneal shunts, prosthetic valve, and in- traocular lens implantation (Chiou et al. 1994; Gir- menia et al. 1996; Painter and Isenberg 1973; Solo- mon et al. 1984; Zahid et al. 1994). The ability to produce large amounts of biofilm on the surface of catheters and other prosthetic devices largely con- tributes to the high frequency of this organism caus- From the Hospital das Clı ´nicas, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil (ASL, SFC, NSM, MB, SIS, CM, AAB); Federal Uni- versity of Sa ˜o Paulo, Sa ˜o Paulo, Brazil (DCG); and University of Campinas, Sa ˜o Paulo, Brazil (MCBV, AZS, MLMB). Address reprint requests to Anna S. Levin, Hospital Infection Control Dept., Hospital das Clı ´nicas, University of Sa ˜o Paulo, Rua Harmonia, 564/52, Sa ˜o Paulo, SP 05435-000, Brazil. Received 14 October 1997; revised and accepted 5 January 1998. DIAGN MICROBIOL INFECT DIS 1998;30:243–249 © 1998 Elsevier Science Inc. All rights reserved. 0732-8893/98/$19.00 655 Avenue of the Americas, New York, NY 10010 PII S0732-8893(98)00006-6