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Utility of fungal blood cultures for patients with AIDS
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Abstract:
This study was designed to define the clinical utility of fungal blood cultures for human immunodeficiency virus type 1-infected individuals. A retrospective chart review was performed for all patients admitted to an inpatient AIDS unit who had evidence of an invasive fungal infection. During a 25-month period, 1,162 fungal blood cultures were performed for 322 patients. These cultures, along with bacterial blood cultures, resulted in the isolation of fungi from 26 patients; 15 of these isolates were considered true pathogens. Routine blood cultures were positive for the fungal isolates in all 15 cases: Candida species and Candida glabrata (6 cases), Cryptococcus neoformans (7), Coccidioides immitis (1), and Histoplasma capsulatum (1). All invasive fungal infections were diagnosed by other means before fungal blood cultures were reported as positive. The results of this study suggest that the routine performance of such cultures in clinical practice should be reevaluated.
Insights
Fungal blood cultures have limited clinical utility for individuals with human immunodeficiency virus type 1 (HIV-1). Invasive fungal infections were diagnosed by other methods before fungal blood culture results were available.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Invasive fungal infections (IFIs) pose a significant threat to individuals with human immunodeficiency virus type 1 (HIV-1).
- Accurate and timely diagnosis of IFIs is crucial for effective patient management.
- The role of routine fungal blood cultures in diagnosing IFIs in HIV-1 patients requires clarification.
Purpose of the Study:
- To evaluate the clinical utility of fungal blood cultures in patients with HIV-1.
- To determine the diagnostic yield of fungal blood cultures for identifying invasive fungal pathogens in this population.
Main Methods:
- Retrospective chart review of patients admitted to an inpatient AIDS unit over a 25-month period.
- Analysis of 1,162 fungal blood cultures performed on 322 patients with evidence of invasive fungal infection.
- Comparison of fungal blood culture results with diagnoses established through other methods.
Main Results:
- Fungi were isolated from 26 patients (8.1%) out of 322, with 15 isolates considered true pathogens.
- Routine blood cultures detected fungal pathogens in all 15 cases, including Candida species, Cryptococcus neoformans, Coccidioides immitis, and Histoplasma capsulatum.
- All invasive fungal infections were diagnosed by alternative methods prior to the availability of positive fungal blood culture results.
Conclusions:
- Routine fungal blood cultures demonstrate limited clinical utility in diagnosing invasive fungal infections in HIV-1-infected individuals.
- The diagnostic yield of fungal blood cultures is low, and diagnoses are often established through other means.
- Reevaluation of the routine performance of fungal blood cultures in clinical practice for this patient population is recommended.