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Published on: October 21, 2010
A Dedicated Mycosis Flask Increases the Likelihood of Identifying Candidemia Sepsis
Magnus G Ahlström1, Valeria S Antsupova1, Michael Pedersen2
1Department of Clinical Microbiology, Herlev & Gentofte Hospital, 2730 Herlev, Denmark.
Introduction:
Candidemia is a severe condition associated with high mortality, and fungi are often not covered by empiric antimicrobial regimes for sepsis. Therefore, the shortest possible time to detection of yeast in the blood is of the essence.
Materials And Methods:
We performed a cohort study of blood culture flasks drawn from patients aged 18 or older in the capital region of Denmark. In 2018 a blood cultures set consisted of two aerobic and two anaerobic flasks. This was changed in 2020 to two aerobic, one anaerobic, and one mycosis flask. We used time-to-event statistics to model time to positivity and compared 2018 with 2020; further, we stratified analyses on the blood culture system used (BacTAlert™ vs. BACTEC™) and high-risk vs. low-risk departments.
Results:
We included 175,416 blood culture sets and 107,077 unique patients. We found an absolute difference in the likelihood of identifying fungi in a blood culture set of 1.2 (95% CI: 0.72; 1.6) pr. 1.000 blood culture sets corresponding to the number needed to treat 853 (617; 1382). In high-risk departments, the absolute difference was profound, whereas it was negligible and statistically non-significant in low-risk departments 5.2 (95% CI: 3.4; 7.1) vs. 0.16 (-0.17; 0.48) pr. 1.000 blood culture sets.
Conclusions:
We found that including a mycosis flask in a blood culture set increases the likelihood of identifying candidemia. The effect was mainly seen in high-risk departments.
Insights
Adding a mycosis flask to blood cultures significantly improves the detection of candidemia, especially in high-risk hospital departments. This enhances early diagnosis of fungal infections, crucial for timely treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Candidemia presents a high mortality risk, often inadequately addressed by standard sepsis antimicrobial regimens.
- Timely detection of yeast in blood cultures is critical for effective patient management.
- Current diagnostic methods may delay the identification of fungal pathogens.
Purpose of the Study:
- To evaluate the impact of incorporating a mycosis flask into blood culture sets on the detection rate of candidemia.
- To compare the diagnostic yield of blood cultures before and after the introduction of mycosis flasks.
- To assess the differential effect of mycosis flasks in high-risk versus low-risk clinical settings.
Main Methods:
- A cohort study analyzed blood culture data from adult patients in the Danish capital region.
- Blood culture protocols were compared between 2018 (aerobic and anaerobic flasks) and 2020 (including a mycosis flask).
- Time-to-positivity statistics were employed, with analyses stratified by blood culture system and patient risk level.
Main Results:
- Over 175,000 blood culture sets from 107,000 patients were analyzed.
- The inclusion of a mycosis flask showed a 1.2 per 1,000 blood culture sets absolute increase in identifying fungi.
- This benefit was significantly pronounced in high-risk departments (5.2 per 1,000) compared to low-risk ones (0.16 per 1,000).
Conclusions:
- The addition of a mycosis flask to blood culture sets demonstrably enhances the identification of candidemia.
- The diagnostic improvement is primarily observed in high-risk patient populations and departments.
- This strategy supports earlier and more accurate diagnosis of invasive fungal infections.
