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Bipolaris Surgical Site Infections among Cardiothoracic Surgery Patients —Texas, Arkansas, and Florida, 2008–2013

Session: Poster Abstract Session: Surgical Site Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
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.

Anne Purfield, PhD1,2, Snigdha Vallabhaneni, MD, MPH1,2, Kaitlin Benedict, MPH1, Shawn Lockhart, PhD1, Cau Pham, PhD1, Ulzii Luvsansharav, MD, PhD2,3, Wendy Chung, MD, MSPH4, Emily Hall, MPH4, Jordan Peart4, Neil Pascoe, RN, BSN5, Gary Heseltine, MD, MPH5, Charlotte Wheeler, RN6, Karen Brust, MD7, Sharon Holmes, MPH8, Prinu Gabriel, MS9, Justin Groves, MPH9, Craig Gilliam, BSMT, CIC10, Christi Zumwalt, RN11, Doramarie Arocha, MS12, Russ Jones, MPH13, D Haselow, MD, PhD14, Laura Lester, DVM MPH2,14, Kelley Garner, MPH14, J. Gary Wheeler, MD14, Sekai Chideya, MD, MPH1, Alison S. Laufer, Ph.D.15 and Benjamin Park, MD1, (1)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Epidemic Intelligence Service, Atlanta, GA, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)Dallas County Department of Health and Human Services, Dallas, TX, (5)Texas Department of State Health Services, Austin, TX, (6)Infection Prevention, Scott and White Hospital, Temple, TX, (7)Scott & White Infectious Disease Division, Temple, TX, (8)Children's Medical Center, Dallas, TX, (9)Texas Health Harris Methodist Fort Worth, Fort Worth, TX, (10)Infection Prevention and Control Department, Arkansas Children's Hospital, Little Rock, AR, (11)Medical City Dallas Hospital/Medical City Children’s Hospital, Dallas, TX, (12)UT Southwestern University Hospitals & Clinics, Dallas, TX, (13)Tarrant County Public Health, Fort Worth, TX, (14)Arkansas Department of Health, Little Rock, AR, (15)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA


A. Purfield, None

S. Vallabhaneni, None

K. Benedict, None

S. Lockhart, None

C. Pham, None

U. Luvsansharav, None

W. Chung, None

E. Hall, None

J. Peart, None

N. Pascoe, None

G. Heseltine, None

C. Wheeler, None

K. Brust, None

S. Holmes, None

P. Gabriel, None

J. Groves, None

C. Gilliam, None

C. Zumwalt, None

D. Arocha, None

R. Jones, None

D. Haselow, None

L. Lester, None

K. Garner, None

J. G. Wheeler, None

S. Chideya, None

A. S. Laufer, None

B. Park, None

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