Outbreak of Cutaneous Rhizopus arrhizus Infection Associated with Karaya Ostomy Bags

Background. We investigated an outbreak involving 2 patients hospitalized at hospital A with cutaneous Rhizopus arrhizus (oryzae) infections of surgically created stomas. Methods. A cohort study involving all patients having ileostomy or colostomy surgery during the outbreak period (January–April 2005) was performed. Environmental samples, including samples obtained from nonsterile karaya (a plant-derived adhesive) ostomy bags and from select hospital areas, were collected. A point prevalence survey was conducted at 5 unrelated hospitals to assess stoma care practices and mold contamination of karaya ostomy bags outside of hospital A. Zygomycete isolates were identified by standard methods. Results. Infections occurred 7 and 10 days after operations for the 2 patients; 1 patient died. In a 21-patient cohort, receiving the equivalent of ⩾0.5 mg/kg per day of prednisone during the week prior to the index date was associated with infection (infection rate, 33% for patients receiving ⩾0.5 mg/kg per day of prednisone vs. 0% for patients receiving