title: A dedicated fungal culture medium is useful in the diagnosis of fungemia: a retrospective cross-sectional study.
abstract: BACKGROUND
  Mortality for candidemia ranges from 15% to 35%. Current guidelines recommend inoculating blood into three aerobic and three anaerobic blood culture bottles when candidemia is suspected, without mention of a fungal blood culture bottle.
  
  
  OBJECTIVE
  To determine the value of the BACTEC Myco/F Lytic blood culture media in the diagnosis of fungemia.
  
  
  METHODS
  A two-year retrospective cross-sectional study was performed for patients who had fungemia with submitted BACTEC Plus Aerobic/F (Aer), BACTEC Plus Anaerobic/F (Anaer) or Myco/F Lytic (Myco) blood culture bottles.
  
  
  RESULTS
  The detection rate of fungemia was 77.4% in 93 patients with contemporaneously submitted blood culture bottles when limited to only Aer/Anaer culture results. The detection rate improved significantly with the addition of the Myco culture bottle results (p<0.0001). A logistic regression model showed that Myco culture bottle submissions were less useful for patients with appropriate anti-fungal therapy administered within 48 hours [OR = 0.18, 95% CI = (0.06, 0.49), p = 0.001] and those with fungal growth detected within 48 hours [OR = 0.33, 95% CI = (0.12, 0.89), p = 0.001]. Among a subset of patients with concordant blood culture results, those with Myco culture bottles submission allowed earlier fungal detection and speciation by at least one day in 27.5% and 25.0% of the cases respectively.
  
  
  CONCLUSIONS
  Our study highlights the importance of a dedicated fungal blood culture when fungemia is clinically suspected. Nearly a quarter of fungemias may be missed if a fungal blood culture is not performed.
authors.affiliation: Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
authors.forename: Shuwei
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Tong Yong
authors.initials: TY
authors.lastname: Ng
authors.affiliation: Health Services Research & Biostatistics Unit, Division of Research, Singapore General Hospital, Singapore, Singapore.
authors.forename: Huihua
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Pathology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ai Ling
authors.initials: AL
authors.lastname: Tan
authors.affiliation: Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
authors.forename: Thuan Tong
authors.initials: TT
authors.lastname: Tan
authors.affiliation: Department Infectious Diseases, Singapore General Hospital, Singapore, Singapore.
authors.forename: Ban Hock
authors.initials: BH
authors.lastname: Tan
mesh_terms: D019411:Clinical Laboratory Techniques / Q000592:standards; D003430:Cross-Sectional Studies; D003470:Culture Media / Q000737:chemistry*; D016469:Fungemia / Q000175:diagnosis* / Q000382:microbiology; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D007755:Laboratories, Hospital; D016017:Odds Ratio; D012189:Retrospective Studies
chemical_list: D003470:Culture Media