Low Utility of Pediatric Isolator Blood Culture System for Detection of Fungemia in Children: a 10-Year Review.
The use of the Wampole Isolator 1.5-ml pediatric blood culture tube for the detection of fungemia in children was assessed by a 10-year retrospective review at two pediatric hospitals, The Hospital for Sick Children in Toronto, Canada, and the Children's Medical Center of Dallas, Texas. Over this period, a total of 9,442 pediatric Isolator specimens were processed, with yeast or yeast-like organisms recovered in 297 (3.1%) of the specimens (151 [1.6%] unique clinical episodes) and filamentous or dimorphic fungi recovered in 31 (0.3%) of the specimens (25 unique clinical episodes). Only 18 of the 151 clinical episodes of fungemia attributable to yeast were not detected by automated blood culture systems. The majority of isolated yeast were Candida spp., which were usually detected by automated systems, whereas the most common non-Candida yeast was Malassezia furfur, which the automated system failed to detect. Filamentous or dimorphic fungi were detected in 25 episodes, of which only 9 (36%) episodes were deemed clinically significant after chart review, indicating that in the majority of cases (16/25, 64%) fungal isolation represented contamination. In five of the nine clinically significant episodes, the isolated fungus (Histoplasma capsulatum, Coccidioides immitis/posadasii, Fusarium oxysporum, Aspergillus spp., and Bipolaris spp.) was also identified in other clinical specimens. Over the 10-year study period, the use of the pediatric Isolator system, at the discretion of the treating physician, only rarely provided useful clinical information for the diagnosis of fungemia in children, with the exception of M. furfur and possibly endemic mycoses.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Aaron
A
Campigotto
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada Division of Microbiology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada susan.richardson@sickkids.ca.
Susan E
SE
Richardson
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Michael
M
Sebert
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA Department of Pathology, Children's Medical Center, Dallas, Texas, USA.
Erin
E
McElvania TeKippe
Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada.
Aparna
A
Chakravarty
Department of Pathology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Christopher D
CD
Doern
D000293:Adolescent; D000071997:Blood Culture / Q000379:methods*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D005260:Female; D016469:Fungemia / Q000175:diagnosis*; D005658:Fungi / Q000145:classification* / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*; D013781:Texas