Candida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing

TitleCandida albicans endocarditis associated with a contaminated aortic valve allograft: implications for regulation of allograft processing
Publication TypeJournal Article
Year of Publication1998
AuthorsKuehnert MJ, Clark E, Lockhart SR, Soll DR, Chia J, Jarvis WR
JournalClin Infect Dis
Volume27
Issue4
Pagination688 - 91
Date PublishedOct
ISSN1058-4838 (Print) 1058-4838 (Linking)
Accession Number9798016
KeywordsAortic Valve / *microbiology / *transplantation, Aortic Valve Insufficiency / *therapy, Candida albicans / drug effects / isolation & purification, Candidiasis / etiology / *microbiology, Endocarditis / *microbiology, Humans, Male, Middle Aged, Postoperative Complications / *microbiology, Transplantation, Homologous
Abstract

A patient developed Candida albicans endocarditis and fungemia after undergoing aortic valve replacement with an allograft. The allograft had been found during tissue bank processing to be contaminated with C. albicans, but it was culture-negative for C. albicans after routine disinfection with an antifungal-containing antimicrobial solution. Comparison of the preimplantation and postimplantation C. albicans isolates revealed remarkable genetic similarity, but antifungal susceptibility testing showed that the postimplantation isolate was more resistant to fluconazole and amphotericin B than the preimplantation isolate, suggesting emergence of resistance after disinfection. Implantation of a contaminated heart valve allograft can occur despite disinfection during processing and can result in endocarditis in the recipient. Antimicrobial disinfection protocols that include antifungal drugs may be ineffective. Current U.S. Food and Drug Administration regulations do not require companies to specify details concerning allograft processing. Additional measures may be required to prevent tissue bank release of allografts contaminated with C. albicans or other pathogens.

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