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Journal of Clinical Microbiology Nov 2007Although several reports have shown that two to three 20-ml blood cultures are adequate for the detection of bacteremia and fungemia in adults, a recent study (F. R....
Although several reports have shown that two to three 20-ml blood cultures are adequate for the detection of bacteremia and fungemia in adults, a recent study (F. R. Cockerill et al., Clin. Infect. Dis. 38:1724-1730, 2004) found that two blood cultures detected only 80% of bloodstream infections and that three blood cultures detected 96% of episodes. We reviewed data at two university hospitals to determine whether the recent observations by Cockerill et al. are applicable more widely. We assessed all blood cultures obtained from adult inpatients from 1 January 2004 through 31 December 2005 at Robert Wood Johnson University Hospital and Duke University Medical Center. All instances in which > or =3 blood cultures per patient were obtained during a 24-h period were included. The medical records of patients who met the inclusion criteria were reviewed retrospectively to determine the clinical significance of the positive blood culture (true infection versus contamination). Data were analyzed to determine the cumulative sensitivity of blood cultures obtained sequentially during the 24-h time period. Of 629 unimicrobial episodes with > or =3 blood cultures obtained during the 24-h period, 460 (73.1%) were detected with the first blood culture, 564 (89.7%) were detected with the first two blood cultures, 618 (98.2%) were detected with the first three blood cultures, and 628 (99.8%) were detected with the first four blood cultures. Of 351 unimicrobial episodes with > or =4 blood cultures obtained during the 24-h period, 257 (73.2%) were detected with the first blood culture, 308 (93.9%) were detected with the first two blood cultures, 340 (96.9%) were detected with the first three blood cultures, and 350 (99.7%) were detected with the first four blood cultures. Among unimicrobial episodes, Staphylococcus aureus was more likely to be detected with the first blood culture (approximately 90% detected with the first blood culture). There were 58 polymicrobial episodes in which > or =3 blood cultures were obtained. Forty-seven (81.0%) were detected with the first blood culture, 54 (93.1%) were detected with the first two blood cultures, and 58 (100%) were detected with the first three blood cultures. The results of this study indicate that two blood cultures in a 24-h period will detect approximately 90% of bloodstream infections in adults. To achieve a detection rate of >99%, as many as four blood cultures may be needed. The previously held axiom that virtually all bloodstream infections can be detected with two to three blood cultures may no longer be valid but may also depend on the definition of the "first" blood culture obtained (see Materials and Methods and Discussion in the text).
Topics: Adult; Bacteremia; Fungemia; Humans; Microbiological Techniques
PubMed: 17881544
DOI: 10.1128/JCM.01555-07 -
BMJ Case Reports Dec 2020The novel COVID-19 has had an unprecedented and devastating spread internationally. COVID-19 infection can lead to a number of cardiovascular sequelae, including heart...
The novel COVID-19 has had an unprecedented and devastating spread internationally. COVID-19 infection can lead to a number of cardiovascular sequelae, including heart failure, which may portend worse clinical outcomes. Here, we report a rare case of a 57-year-old woman who developed acute left ventricular systolic dysfunction with apical ballooning consistent with takotsubo cardiomyopathy (TCM), and mixed cardiogenic and septic shock in the setting of COVID-19 disease. We briefly review the pathophysiology and diagnosis of TCM (also described as apical ballooning syndrome and stress-induced cardiomyopathy). Additionally, this case highlights the importance of a multidisciplinary approach to clinical decision-making and resource allocation in diagnosis and management of critical illness in the setting of the ongoing international COVID-19 pandemic.
Topics: COVID-19; Female; Fungemia; Humans; Middle Aged; SARS-CoV-2; Takotsubo Cardiomyopathy
PubMed: 33310830
DOI: 10.1136/bcr-2020-236811 -
PLoS Neglected Tropical Diseases Jul 2023Candida haemulonii complex-related species are pathogenic yeasts closely related to Candida auris with intrinsic antifungal resistance, but few epidemiological data are... (Review)
Review
BACKGROUND
Candida haemulonii complex-related species are pathogenic yeasts closely related to Candida auris with intrinsic antifungal resistance, but few epidemiological data are available.
METHODOLOGY/PRINCIPAL FINDINGS
We analyzed clinical and demographic characteristics of patients with fungemia due to C. haemulonii complex and related species (C. pseudohaemulonii, C. vulturna) reported in France during 2002-2021, and compared them to data of C. parapsilosis fungemia, as they all can be commensal of the skin. We also conducted a study on adult inpatients and outpatients colonized by C. haemulonii complex, managed at the University Hospital of Martinique during 2014-2020. Finally, we performed a literature review of fungemia due to C. haemulonii complex and related species reported in Medline (1962-2022). In total, we identified 28 fungemia due to C. haemulonii complex in France. These episodes were frequently associated with bacterial infection (38%) and high mortality rate (44%), and differed from C. parapsilosis fungemia by their tropical origin, mainly from Caribbean and Latin America. All isolates showed decreased in vitro susceptibility to amphotericin B and fluconazole. In Martinique, we found that skin colonization was frequent in the community population, while colonization was strongly associated with the presence of foreign devices in ICU patients. The literature review identified 274 fungemia episodes, of which 56 were individually described. As in our national series, published cases originated mainly from tropical regions and exhibited high crude mortality.
CONCLUSIONS/SIGNIFICANCE
Multidrug-resistant C. haemulonii complex-related species are responsible for fungemia and colonization in community and hospital settings, especially in tropical regions, warranting closer epidemiological surveillance to prevent a potential C. auris-like threat.
Topics: Adult; Antifungal Agents; Candida; Candidiasis; Microbial Sensitivity Tests; Humans; Hospitals, University; Saccharomycetales; Fungemia
PubMed: 37523406
DOI: 10.1371/journal.pntd.0011453 -
BMC Pediatrics Apr 2025In pediatric and neonatal age groups, infections from non-neoformans Cryptococcus species, notably Cryptococcus albidus, are rarely encountered. C. albidus is an... (Review)
Review
BACKGROUND
In pediatric and neonatal age groups, infections from non-neoformans Cryptococcus species, notably Cryptococcus albidus, are rarely encountered. C. albidus is an emerging fungal pathogen that causes severe diseases in immunosuppressed patients; furthermore, it has rarely been reported to cause diseases in immunocompetent patients. Several cases have been described in adults who were severely immunosuppressed. Importantly, the clinical symptoms in these reported cases include fungemia, meningitis, keratitis, pulmonary and cutaneous infections. Individuals at risk include neutropenic patients, those with indwelling intravenous devices, those on prolonged steroid or antibiotic use, and those with impaired immune systems and prematurity. The susceptibility of preterm infants with low birth weight to infections, particularly fungal ones, remains a significant concern. This report presents a rare case of fungemia and meningitis due to C. albidus in a preterm neonate, emphasizing the clinical significance and potential implications for future treatment and management. This report aims to alert physicians of the rarity of C. albidus infections in pediatric patients and to review the clinical significance, pathology, treatment, and outcomes.
CASE PRESENTATION
We report the first case of C. albidus fungemia and meningitis in a very low-birth-weight, preterm infant of 31 weeks. Notably, the patient was admitted for lifesaving treatment from the Alleith Hospital due to prematurity. The patient received surfactant due to ARDS, TPN, and fluconazole prophylaxis. On day 11, features of sepsis were observed and the blood culture grew C. albidus, which was sensitive to liposomal agents. CSF evaluation suggested meningitis. The patient improved following a six-week treatment regimen with liposomal formulations of amphotericin B at a dosage of 5 mg/kg body weight once daily, notably administered without 5-fluorocytosine, and experienced no sequelae.
CONCLUSIONS
This case report underscores the importance of early diagnosis and appropriate antifungal treatment for managing rare fungal infections in vulnerable populations, such as preterm infants. Moreover, it highlights the need for improved diagnostic platforms and comprehensive management protocols for rare pathogens in neonatal settings.
Topics: Humans; Infant, Newborn; Antifungal Agents; Infant, Premature, Diseases; Fungemia; Meningitis, Cryptococcal; Male; Infant, Premature; Amphotericin B; Cryptococcus; Cryptococcosis; Female; Fluconazole; Meningitis, Fungal
PubMed: 40175917
DOI: 10.1186/s12887-025-05614-8 -
Pathogens (Basel, Switzerland) Mar 2024has been previously classified as , , and and was recently reclassified in the genus after phylogenetic analysis of its genetic sequence. An increasing number of... (Review)
Review
has been previously classified as , , and and was recently reclassified in the genus after phylogenetic analysis of its genetic sequence. An increasing number of reports of human infections by have emerged, suggesting that this microorganism is an emerging pathogen. The present review aimed to provide data on the epidemiology, antifungal resistance, clinical characteristics, treatment, and outcomes of fungemia by by extracting all the available information from published original reports in the literature. PubMed/Medline, Cochrane Library, and Scopus databases were searched for eligible articles reporting data on patients with this disease. In total, 36 studies involving 170 patients were included. The age of patients with fungemia by ranged from 0 to 89 years; the mean age was 22.8 years, the median age was 2.2 years, with more than 37 patients being less than one month old, and 54% (88 out of 163 patients) were male. Regarding patients' history, 70.4% had a central venous catheter use (CVC), 28.7% were on total parenteral nutrition (TPN), 97% of neonates were hospitalized in the neonatal ICU (NICU), and 39.4% of the rest of the patients were hospitalized in the intensive care unit (ICU). Previous antimicrobial use was noted in 65.9% of patients. The most common identification method was the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in 34.1%, VITEK and VITEK 2 in 20.6%, and ID32 C in 15.3%. had minimal antifungal resistance to fluconazole, echinocandins, and amphotericin B, the most commonly used antifungals for treatment. Fever and sepsis were the most common clinical presentation noted in 95.8% and 86%, respectively. Overall mortality was 20% and was slightly higher in patients older than one year. Due to the rarity of this disease, future multicenter studies should be performed to adequately characterize patients' characteristics, treatment, and outcomes, which will increase our understanding and allow drawing safer conclusions regarding optimal management.
Topics: Humans; Fungemia; Antifungal Agents; Saccharomycetales; Drug Resistance, Fungal; Child; Adult; Adolescent; Young Adult; Infant; Child, Preschool; Male; Aged, 80 and over; Infant, Newborn; Aged; Female; Middle Aged; Microbial Sensitivity Tests
PubMed: 38535612
DOI: 10.3390/pathogens13030269 -
BMJ Case Reports Dec 2015
Topics: Antifungal Agents; Candida glabrata; Caspofungin; Crohn Disease; Echinocandins; Exanthema; Fungemia; Humans; Lipopeptides; Male; Parenteral Nutrition; Young Adult
PubMed: 26677155
DOI: 10.1136/bcr-2015-212721 -
Frontiers in Cellular and Infection... 2020spp. are lipid-dependent yeasts, inhabiting the skin and mucosa of humans and animals. They are involved in a variety of skin disorders in humans and animals and may... (Review)
Review
spp. are lipid-dependent yeasts, inhabiting the skin and mucosa of humans and animals. They are involved in a variety of skin disorders in humans and animals and may cause bloodstream infections in severely immunocompromised patients. Despite a tremendous increase in scientific knowledge of these yeasts during the last two decades, the epidemiology of spp. related to fungemia remains largely underestimated most likely due to the difficulty in the isolation of these yeasts species due to their lipid-dependence. This review summarizes and discusses the most recent literature on spp. infection and fungemia, its occurrence, pathogenicity mechanisms, diagnostic methods, susceptibility testing and therapeutic approaches.
Topics: Animals; Antifungal Agents; Fungemia; Humans; Immunocompromised Host; Malassezia; Skin
PubMed: 32850475
DOI: 10.3389/fcimb.2020.00370 -
Clinical Microbiology Reviews Jul 1997The presence of microorganisms in a patient's blood is a critical determinant of the severity of the patient's illness. Equally important, the laboratory isolation and... (Review)
Review
The presence of microorganisms in a patient's blood is a critical determinant of the severity of the patient's illness. Equally important, the laboratory isolation and identification of a microorganism present in blood determine the etiologic agent of infection, especially when the site of infection is localized and difficult to access. This review addresses the pathophysiology and clinical characteristics of bacteremia, fungemia, and sepsis; diagnostic strategies and critical factors in the detection of positive blood cultures; characteristics of manual and instrument approaches to bacteremia detection; approaches for isolating specific microorganisms associated with positive blood cultures; and rapid methods for the identification of microorganisms in blood cultures.
Topics: Bacteremia; Bacteriological Techniques; Brucella; Campylobacter; Fungemia; Humans; Legionella; Mycology; Mycoplasma; Prognosis
PubMed: 9227861
DOI: 10.1128/CMR.10.3.444 -
European Review For Medical and... Aug 2023Recent research has suggested that fungemia may demonstrate an epidemiologic shift in etiologic agents. This study focuses on the agents causing fungemia and antifungal...
OBJECTIVE
Recent research has suggested that fungemia may demonstrate an epidemiologic shift in etiologic agents. This study focuses on the agents causing fungemia and antifungal resistance in a tertiary hospital.
PATIENTS AND METHODS
We evaluated all-age fungemia cases admitted to Balikesir Ataturk City Hospital in 2017-2021. Blood cultures (BC) were studied using BacT/Alert® 3D (bioMérieux, Marcyl'Etoile, France) and Render BC128 System (Render Biotech Co. Ltd., Shenzhen, China). On the data, we explored only the first fungal positive samples or the first isolates in different episodes of the same patients. Upon The Clinical and Laboratory Standards Institute (CLSI) disk diffusion guidelines, conventional methods and the Phoenix™ 100 System (Becton Dickinson, Franklin Lakes, NJ, USA) were utilized for antifungal susceptibility identifications.
RESULTS
The findings showed that 325 (0.84%) of 38,682 BC sets were positive for fungal growth. Except for four cases (1.2%) [Saprochaete capitata (n = 2); Trichosporon asahii (n = 1), and Saccharomyces cerevisiae (n = 1)], all positive cases yielded Candida spp. (98.8%) growth. In these patients, the following Candida spp. were isolated: Candida albicans complex (n = 155; 47.7%), Candida parapsilosis complex (n = 127; 39.1%), Candida glabrata complex (n = 19; 5.85%), Candida tropicalis (n = 12; 3.7%), Candida kefyr (n = 5; 1.54%), Candida krusei (n = 2; 0.62%), and Candida guilliermondii complex (n = 1; 0.31%). We also realized that while none of the Candida spp. had echinocandin resistance, 8 C. parapsilosis complex isolates were resistant to fluconazole, and 17 C. parapsilosis complex and 2 C. tropicalis isolates were susceptible dose-dependent to fluconazole.
CONCLUSIONS
In brief, antifungal resistance is more likely to restrict therapeutic options, albeit it is, fortunately, not prevalent in Turkey despite a few recent reports. Yet, a robust detection or management of antifungal resistance requires species-level identification and strict compliance with relevant management guidelines. Besides, challenges in research may be compensated with a national data set built with data from local laboratories.
Topics: Humans; Fungemia; Fluconazole; Antifungal Agents; Candida; Candida albicans
PubMed: 37667920
DOI: 10.26355/eurrev_202308_33395 -
Infection Control and Hospital... Feb 2024Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3...
OBJECTIVE
Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs).
DESIGN, SETTING, AND PARTICIPANTS
All consecutive blood cultures performed for 6 months during 2020-2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line-associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability.
RESULTS
Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability.
CONCLUSIONS
HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.
Topics: Humans; Fungemia; Catheter-Related Infections; Retrospective Studies; Bacteremia; Cross Infection; Hospitals; Sepsis; Catheterization, Central Venous
PubMed: 37593953
DOI: 10.1017/ice.2023.170