Fungal Bloodstream Infections Associated with a Compounded Intravenous Medication at an Outpatient Oncology Clinic - New York City, 2016

On May 24, 2016, the New York City Department of Health and Mental Hygiene notified CDC of two cases of Exophiala dermatitidis bloodstream infections among patients with malignancies who had received care from a single physician at an outpatient oncology facility (clinic A). Review of January 1- May 31, 2016 microbiology records identified E. dermatitidis bloodstream infections in two additional patients who also had received care at clinic A. All four patients had implanted vascular access ports and had received intravenous (IV) medications, including a compounded IV flush solution containing saline, heparin, vancomycin, and ceftazidime, compounded and administered at clinic A. E. dermatitidis (previously known as Wangiella dermatitidis) is a neurotropic, dark pigment-forming fungus that is found in the environment. Health care-associated infections have been reported and include catheter-associated fungemia and an outbreak of E. dermatitidis meningitis associated with contaminated injectable steroids prepared by a compounding pharmacy.