Lack of utility of the lysis-centrifugation blood culture method for detection of fungemia in immunocompromised cancer patients.
We retrospectively compared the utility of a fungal isolation device (Isolator) versus conventional techniques for recovering fungal organisms from blood cultures obtained from neutropenic cancer patients. Positive cultures were deemed true pathogens, possible pathogens, or contaminants according to laboratory and clinical criteria. Fifty-three patients had 66 positive blood cultures for fungi, nine on multiple occasions. In 20 episodes true pathogens were recovered, 6 from broth medium alone, 4 from the Isolator system alone, and 10 from both systems. False-negative cultures were noted in 4 of 20 (20%) cases in which broth medium was used and in 6 of 20 (30%) cases in which the Isolator system was used. Possible pathogens were detected in 4 of 66 blood culture-positive cases. Forty-two positive cultures were considered contaminants, 1 collected from standard medium and 41 of 42 (98%) which grew only in Isolators. Eleven of 18 patients with true fungal infections expired as a result of infection, while 4 of 33 patients with a contaminant expired, none from a fungal cause. We do not advocate the routine use of Isolator tubes in the evaluation of the febrile, neutropenic patient due to the high rates of false positives and of contamination.
Creger
R J
RJ
Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106, USA.
Weeman
K E
KE
Jacobs
M R
MR
Morrissey
A
A
Parker
P
P
Fox
R M
RM
Lazarus
H M
HM
D000328:Adult; D000368:Aged; D002498:Centrifugation; D005260:Female; D016469:Fungemia / Q000175:diagnosis*; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology*; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies