Candida Osteomyelitis and Diskitis after Spinal Surgery: An Outbreak That Implicates Artificial Nail Use

Abstract

Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to Candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.

Candida albicans osteomyelitis of the spine: progressive clinical and radiological features and surgical management in three cases

“…In 1998, Anderamahr reported a case of lumbar spondylitis due to Candida and reviewed 31 adult cases with vertebral osteomyelitis from the literature [2]. Since then, further 14 cases with vertebral involvement were reported [9,10,18,21,23,24], including three cases of Candida albicans vertebral osteomyelitis and discitis following laminectomy [18] which were attributed to wearing artificial nails by an operating room technician who was scrubbed for all these patients.…”

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

“…[399][400][401] Artificial nails worn by healthcare personnel have been associated with outbreaks of infectious agents, including P. aeruginosa. [402][403][404][405] While no specific studies of the role played by artificial nails in the transmission of pathogens in CF have been performed, the clinical experience in ICUs and other healthcare settings can be applied to CF. Thus, healthcare personnel who provide care to people with CF should not wear artificial nails.…”

Infection Control in Cystic Fibrosis

“…HCWs wearing artificial nails are more likely to harbor gram-negative pathogens than are HCWs with natural nails, even after washing (128). Artificial nails have been linked to outbreaks of infectious agents, including P. aeruginosa, in intensive care units (67,134,147,148). Although studies have not documented that artificial nails play a role in the transmission of pathogens among CF patients, the experience in intensive care units can extend to CF settings.…”