Abstract
BackgroundFew studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome.MethodsA historical cohort study with 89 adults patients with C. albicans BSIs. TTP was defined as the time between the start of incubation and the time that the automated alert signal indicating growth in the culture bottle sounded.ResultsPatients with BSIs and TTPs of culture of ≤36 h (n=39) and >36 h (n=50) were compared. Septic shock occurred in 46.2% of patients with TTPs of ≤36 h and in 40.0% of patients with TTP of >36 h (p=0.56). A central venous catheter source was more common with a BSI TTP of ≤36 h (p=0.04). Univariate analyis revealed that APACHE II score≥20 at BSI onset, the development of at least one organ system failure (respiratory, cardiovascular, renal, hematologic, or hepatic), SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death. By using logistic regression analysis, the only independent predictor of death was time to positivity (1.04; 95% CI, 1.0-1.1, p=0.035), with the chance of the patient with C. albicans BSI dying increasing 4.0% every hour prior to culture positivity.ConclusionA longer time to positivity was associated with a higher mortality for Candida albicans BSIs; therefore, initiating empiric treatment with antifungals may improve outcomes.
Highlights
Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs)
101 patients were excluded; 14 patients were on antifungal therapy when blood samples for culture were obtained, 22 patients because they had polymicrobial BSIs, and 65 due to incomplete data in medical records
Univarate analysis revealed that APACHE II score≥20 at BSI onset, the development of at least one organ system failure, SOFA at BSI onset, SAPS II at BSI onset, and time to positivity were associated with death (Table 3)
Summary
Few studies have assessed the time to blood culture positivity as a predictor of clinical outcome in fungal bloodstream infections (BSIs). The purpose of this study was to evaluate the time to positivity (TTP) of blood cultures in patients with Candida albicans BSIs and to assess its impact on clinical outcome. The use of automated systems for blood cultures was one of the great advances in the diagnosis of candidemia [4,5]. This method offers improved sensitivity, which is estimated to be approximately 70% [5]. The increase in non-albicans species, carries therapeutic implications because the pattern of susceptibility to azoles is species-specific [3,6]
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