Effect of fluconazole prophylaxis on fungal blood cultures: an autopsy-based study involving 720 patients with haematological malignancy.
To investigate the utility of blood culture of invasive fungal infections in patients with haematological malignancies, an autopsy survey was conducted in 720 patients who were treated between 1980 and 1999. We identified 252 patients with invasive mycosis. These included Candida (n = 94), Aspergillus (n = 91), Zygomycetes (n = 34), Cryptococcus (n = 7), Trichosporon (n = 11), Fusarium (n = 1), and unknown fungi (n = 20). Of the 94 patients with invasive candidiasis, 20 had positive blood cultures. Of the 11 patients with invasive trichosporonosis, seven had positive blood cultures. The sensitivities of blood cultures were 1.1%, 0% and 14% for detecting invasive aspergillosis, zygomycosis and cryptococcosis respectively. Multiple regression analysis showed a significant correlation between results of Candida blood cultures and some variables, including prophylactic use of absorbable antifungals (P = 0.0181) and infection by Candida albicans (P = 0.0086). The sensitivity of blood cultures decreased when patients received antifungal chemoprophylaxis. Unless these agents are inactivated in culture bottles, conventional blood cultures might produce false-negative results.
Kami
Masahiro
M
Department of Hematology, Toranomon Hospital, Tokyo, Japan. mkami@ncc.go.jp
Machida
Utako
U
Okuzumi
Katsuko
K
Matsumura
Tomoko
T
Mori Si
Shin-ichiro
S
Hori
Akiko
A
Kashima
Takeshi
T
Kanda
Yoshinobu
Y
Takaue
Yoichi
Y
Sakamaki
Hisashi
H
Hirai
Hisamaru
H
Yoneyama
Akiko
A
Mutou
Yoshitomo
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis; D001344:Autopsy; D002177:Candidiasis / Q000175:diagnosis; D003453:Cryptococcosis / Q000175:diagnosis; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005658:Fungi / Q000302:isolation & purification*; D005670:Fusarium; D019337:Hematologic Neoplasms / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009172:Mycology / Q000379:methods; D009181:Mycoses / Q000175:diagnosis* / Q000517:prevention & control; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014250:Trichosporon; D020096:Zygomycosis / Q000175:diagnosis
D000935:Antifungal Agents; D015725:Fluconazole