title: Impact of systemic antifungal therapy on the detection of Candida species in blood cultures in clinical cases of candidemia.
abstract: The diagnosis and follow-up of candidemia still rely on blood cultures (BCs). In vitro studies show that antifungals can significantly modify the result of blood culture not containing adsorbing agents. We aimed to evaluate, under clinical conditions, the impact on BC yeast detection of systemic antifungal therapy (SAT). Patients (n = 125) experiencing candidemia at Grenoble University Hospital (France) were included in a 4-year retrospective study. The Plus Aerobic/F (Aerobic) and Plus Anaerobic/F (Anaerobic) bottles, which both contain adsorbing resins and the non-resin selective Mycosis IC/F (Mycosis) bottles, were compared using multivariate hierarchical models adjusted for clinical characteristics. The positivity rate (PR) is decreased in patients with SAT (p < 0.01), abdominal surgery (p = 0.01), and hemodialysis (p = 0.02). In all bottles, SAT reduces PR by a factor of 0.16 (95 % CI: [0.08; 0.32]) and increases the time to positivity (TTP) by a factor of 1.76 ([1.30; 2.40]; p < 0.01). In the presence of SAT, TTP is higher in non-resin bottles (Mycosis) than in resin bottles (RR = 1.76, [1.30; 2.40]); however, the TTP in nonresin and resin bottles remains comparable. Although discordant results are observed with and without SAT (37 and 58 % respectively), we showed that the presence of SAT decreases significantly the agreement rate by a factor of 0.29 (CI: [0.12; 0.68]). The combination of Anaerobic and Mycosis bottles allowed a 100 % positivity rate for C. glabrata. SAT significantly affects BC results. Because they provide additional and complementary results, this study supports the concomitant use of resin and selective bottles, especially in patients receiving SAT.
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France.|U823, Université Grenoble Alpes, Saint-Martin-d'Hères, France.|UMR 1137-IAME Team 5-DeSCID, Inserm/Paris Diderot, Sorbonne Paris Cité University, Paris, France.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-2179-4650
authors.initials: S
authors.lastname: Bailly
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France.|Laboratoire TIMC-TheREx, UMR 5525 CNRS-UJF, Université Grenoble Alpes, Saint-Martin-d'Hères, France.
authors.forename: C
authors.initials: C
authors.lastname: Garnaud
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France.|Laboratoire TIMC-TheREx, UMR 5525 CNRS-UJF, Université Grenoble Alpes, Saint-Martin-d'Hères, France.
authors.forename: M
authors.initials: M
authors.lastname: Cornet
authors.affiliation: Département des maladies infectieuses, CHU Grenoble, Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Pavese
authors.affiliation: Réanimation médicale, CHU Grenoble, Grenoble, France.
authors.forename: R
authors.initials: R
authors.lastname: Hamidfar-Roy
authors.affiliation: Pharmacie hospitalière, CHU Grenoble, Grenoble, France.
authors.forename: L
authors.initials: L
authors.lastname: Foroni
authors.affiliation: Laboratoire de Bactériologie-Hygiène, Institut de Biologie et de Pathologie, CHU Grenoble, Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Boisset
authors.affiliation: UMR 1137-IAME Team 5-DeSCID, Inserm/Paris Diderot, Sorbonne Paris Cité University, Paris, France.|Réanimation Médicale et des Maladies Infectieuses, Hôpital Bichat, Paris, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Institut de Biologie et de Pathologie, CHU de Grenoble, Grenoble, France. dmaubon@chu-grenoble.fr.|Laboratoire TIMC-TheREx, UMR 5525 CNRS-UJF, Université Grenoble Alpes, Saint-Martin-d'Hères, France. dmaubon@chu-grenoble.fr.
authors.forename: D
authors.initials: D
authors.lastname: Maubon
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification; D058387:Candidemia; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents