PROCAARE: Utility of fungal blood cultures

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Reference: Mess, T., Baar, E.S. (1997).  Utility of fungal blood cultures
for patients with AIDS.  Clin. Infect. Dis. 25: 1350-3.

This retrospective study evaluated patients admitted to an inpatient AIDS
unit at Cedar-Sinai Medical Center in Los Angeles.  Routine blood cultures
were analyzed using the BACTEC culture system, and fungal blood cultures
employed the Dupont isolator system (a lysis centrifugation method
followed by inoculation into Sabouraud brain-heart infusion agar).

During a two-year period, 1,162 fungal cultures were obtained on 322
patients.  Overall 26 fungal isolates were identified from routine and
fungal cultures, and 15 of these were considered clinical significant.
Fungal blood cultures did not reveal any isolates which were not
identified upon routine culture.  In six cases Candida species and C.
glabrata were found; seven isolates of Cryptococcus neoformans were
identified along with one each of C. immitis and H. capsulatum.  In all
cases of invasive fungal infections, other diagnostic means (e.g. routine
blood culture, serology, biopsy, etc.) elucidated the etiologic agent
before fungal blood cultures became positive.  Although prospective data
are needed, and although  endemic mycoses such as H. capsulatum and P.
marneffei had a low prevalence in the geographic region studied, these
results call into question the routine use of fungal blood cultures in the
care of febrile HIV-1-infected patients.

KEYWORDS: CLINICAL SCIENCE, FUNGAL BLOOD CULTURE, UTILITY, CANDIDA,
CRYPTOCOCCUS, HISTOPLASMA

From: Albert Shaw<ashaw@usa.healthnet.org>
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