High Rate of Candidemia in Patients Sustaining Injuries in a Bomb Blast at a Marketplace: A Possible Environmental Source

Abstract

In this study, a cluster of candidemia among patients sustaining injuries in a bomb blast at a marketplace was investigated by means of a multivariate analysis, a case-control study, and quantitative air sampling. Candidemia occurred in 7 (30%) of 21 patients (58% of those admitted to the intensive care unit [ICU]) between 4 and 16 days (mean, 12 days) after the injury and was the single most frequent cause of bloodstream infections. Inhalation injury was the strongest predictor for candidemia by multivariate analysis. Candidemia among the case patients occurred at a significantly higher rate than among comparable trauma patients injured in different urban settings, including a pedestrian mall (2 of 29; P=. 02), and among contemporary ICU control patients (1 of 40; P=.001). Air sampling revealed exclusive detection of Candida species and increased mold concentration in the market in comparison with the mall environment. These findings suggest a role for an exogenous, environmental source in the development of candidemia in some trauma patients.

Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards

“…52 Literature from Israel and other parts of the world indicate a clear rise in HAI caused by candida and other fungi over the past few years. [52][53][54][55] This study has limitations and the findings should be interpreted with caution. To determine conclusively whether invasive procedures adopted in ICUs explain the increased risk of infection, a randomized clinical trial is required.…”

Occupation, Lifestyle, Diet, and Invasive Fungal Infections

“…These syringes were kept in a temporary, dusty, damp warehouse, while the better storage space was filled with overseas aid [81]. Finally, a cluster of candidemia cases occurred among patients who sustained injuries in a bomb blast at a marketplace in Israel [82].…”

Wound Fragments from Cutaneous Sites of U.S. Military Personnel Deployed in Operation Iraqi Freedom: Clinical Aspects and Pathologic Characterizations

“…Although in this study the majority of the specimens were the extracted wound fragments alone, and infection was not the primary indication for removal, the propensity for the environment to influence the rate of infection among the wounded should be borne in mind. A report from Israel noted a high rate of candidemia in patients wounded by a bomb blast in a marketplace when compared to other cohorts of bomb victims injured in different environments and confirmed the presence of Candida species in air samples from the market 20 …”