title: Effect of fluconazole prophylaxis on fungal blood cultures: an autopsy-based study involving 720 patients with haematological malignancy.
abstract: 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.
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan. mkami@ncc.go.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Utako
authors.initials: U
authors.lastname: Machida
authors.forename: Katsuko
authors.initials: K
authors.lastname: Okuzumi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumura
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Mori Si
authors.forename: Akiko
authors.initials: A
authors.lastname: Hori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kashima
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Hisamaru
authors.initials: H
authors.lastname: Hirai
authors.forename: Akiko
authors.initials: A
authors.lastname: Yoneyama
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Mutou
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole