Two Patients Colonised with Absidia Corymbifera in an Intensive Care Unit Likely Secondary to an Abnormally Plumbed Renal Dialysis Point

Abstract

Background Two adult patients within our adult intensive care unit grew Absidia corymbifera from clinical samples 24 hours apart. Both patients were colonised with the organism although one patient with a serious underlying condition did receive antifungal therapy. Due to the serious nature of Mucormycosis an infection control investigation was undertaken to identify and address any underlying sources with the aim of preventing further cases. Methods Visual inspection of the patient's environment was undertaken for investigation of water ingress or visible mould. Other investigations included air sampling and sampling of bed linen and shared equipment between patients. Results On review of one of the patient bedrooms an area of recent water ingress was identified. This was a plumbed in dialysis point which on further exploration had an abnormal plumbing collection to a sluice. As a result, there had been reflux of bed pan pulp into the wall space. Air sampling was negative. Swabs of linen were also negative and an ultrasound machine which was the only shared piece of equipment was also excluded. There was no construction work in the vicinity and checks on the patient's room ventilation parameters were satisfactory Conclusions It is likely the source of Absidia corymbifera was water ingress from an abnormally plumbed dialysis point in one of the patient bedrooms. Damp bed pan pulp supports the growth of fungi and if not removed within 72 hours will support fungal proliferation. Mould accumulating in a wall due to a slow water leak is thought to have played a role in cases of Mucor in the published literature. Fungal spores are released in bursts and travel far and wide which would explain colonisation in another patient in the unit at the same time. Following removal of the pulp and remedial plumbing no further cases were noted.