Persistent fungemia--risk factors and outcome in 40 episodes

The aim of this multicenter survey was to assess risk factors and mortality in patients with persistent fungemia (PF). Cases of persistent fungemia, defined as positive blood culture for at least 3 causative days of antifungal therapy were selected. Forty cases of persistent fungemia (lasting more than 3 days) were compared with 270 non-persistent fungemias appearing within the same period, and analyzed by univariate and multivariate analysis for risk factors and outcome. The median number of days of positive culture was 4.4 (3 - 20): 22 episodes were due to Candida albicans, 1 due to non-albicans Candida spp., 6 episodes due to non-Candida spp. Yeasts: 15 were catheter related, 16 patients had yeast-infected surgical wounds, 12 were neutropenic, 4 cases were caused by species resistant in vitro, 2 to amphotericin B (Trichosporon spp.) and 2 to fluconazole (C. laurentii, C. glabrata). Fifteen patients (37.5%) died, 7 of whom due to fungemia. Nineteen cases had one known risk factor (10 had infected wound, 4 infected vascular catheter, 3 were neutropenic and 2 had inappropriate therapy). Fourteen cases had two known risk factors (4 had wound and infected catheter, 4 neutropenia and infected catheter, 2 neutropenia and resistant organism, 4 other combinations. Two cases had 3 known risk factors and one had 4 risk factors for persistent fungemia. Artificial ventilation, C. glabrata etiology, non-Candida spp. yeasts such as Trichosporon spp. and Cryptococcus spp. and prior surgery were significantly associated with persistent fungemia in univariate, whereas only C. glabrata etiology in multivariate analysis. Breakthrough fungemia during empiric therapy with fluconazole was also observed more frequently in patients with persistent fungemia. However, there was no difference in both attributable and overall mortality between both groups.     

Neonatal candidaemia in Kuwait: a 12-year study of risk factors, species spectrum and antifungal susceptibility

A study of candidaemia in neonatal intensive care unit (NICU) over a 12-year period (1995–2006) taking into consideration demographic variables, risk factors, aetiological Candida species and therapeutic outcomes is presented. The yeast isolates were identified by VITEK2 yeast identification system and antifungal susceptibility was determined by E-test. Of 4815 neonates admitted in NICU, 182 cases of candidaemia were detected with an overall prevalence of 4.0% and crude mortality of 27.7%. The annual rate of candidaemia per 1000 admissions was the highest in 1997 (84 cases) and the lowest in 2004 (10 cases). Of the 112 assessable candidaemia cases, 78 (70%) occurred in very low birth weight neonates (≤1500 g), 65 (58%) were born with gestational age of ≤30 weeks. The main identifiable risk factors were use of ≥2 antibiotics (87%), total parenteral nutrition for >5 days (82%), placement of central venous catheter (78%) and prior colonisation with Candida species (54%). Candida albicans and non- albicans Candida species accounted for 43% and 57% of candidaemia cases, respectively, and C. parapsilosis emerged as a predominant species. No fluconazole resistance was observed in C. albicans and C. parapsilosis isolates. This is the first comprehensive study on the epidemiology of neonatal candidiasis in Kuwait.     

Candidaemia: a 10-year study in an Indian teaching hospital

Retrospective evaluation of candidaemia patients was performed in an Indian teaching hospital over a 10-year period. The incidence of patients with candidaemia increased eleven-fold in the second half of the study period (55 patients) compared with the first half (5 patients). Haematological malignancies (11 patients), neonatal septicaemia (9), cardiac abnormalities and cardiac surgery (9) were the commonest underlying diseases in these patients. Candida albicans (50%), C. guilliermondii (17%), C. tropicalis (15%) and C. parapsilosis (8%) were the most common fungal pathogens isolated from blood culture. Therapy with two or more antibiotics (92%), corticosteroid administration (25%), intravascular catheter use for over 24 h (78%) and neutropenia (48%) were the accountable predisposing factors. Prolonged hospitalization (mean average 22.2 days as compared with 11.2 days in other patients) was an added risk factor in these patients.     

Candidaemia in a London teaching hospital: analysis of 128 cases over a 7-year period

In a retrospective analysis of 128 cases of Candida bloodstream infections in a London teaching hospital between 1995 and 2001, the incidence of candidaemia increased from 0.2/1000 admissions in 1995 to 0.5 and 0.4/1000 admissions in 2000 and 2001, respectively. Risk factors for candidaemia included the presence of intravascular (IV) lines (88%), admission to intensive care (51%), parenteral nutrition (35%), multiple antibiotics (74%), corticosteroid therapy (12%), cancer chemotherapy (11%), renal transplantation (5%) and neutropenia (3%). The sources of infection were IV lines (77%), the urinary tract (7%) and the gastrointestinal tract (7%). Serious infective complications (endocarditis, endophthalmitis or brain abscess) were noted in 6% of cases. The most frequently isolated species were Candida albicans (64%), C. glabrata (20%), C. tropicalis (9%) and C. parapsilosis (5%). The overall fluconazole-resistance rate of Candida spp. was 7% (MIC > or = 64 mg l-1). All the C. albicans isolates were sensitive to fluconazole (MIC < or = 8 mg l-1) whereas 20% of non-C. albicans isolates (27% of C. glabrata and 14%C. tropicalis) were resistant. The mortality rate (35%) was lower than in other reports and may be due to the early recognition of candidaemia and the prompt removal of IV lines together with the initiation of appropriate antifungal therapy. Regular surveillance of local Candida species, resistance profiles and risk factors is important in order to identify patients at risk and to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.     

Risk factors for candidaemia in critically ill patients: a prospective surveillance study

Candidaemia is frequently a life-threatening complication in patients admitted to the intensive care unit (ICU). To assess the risk factors for candidaemia in critically ill patients with prolonged ICU stay, a total of 1765 adult patients admitted for at least 7 days to 73 medical-surgical ICUs of 70 tertiary care hospitals in Spain participated in a prospective cohort study. Candidaemia was defined as recovery of Candida spp. from blood culture. Sixty-eight episodes of candidaemia occurred in 63 patients, representing 35.7 episodes per 1000 ICU patients admitted, with an incidence rate of 1.5 episodes per 1000 days of ICU stay. Causative fungi were C. albicans in 57.1% of cases and non-albicans Candida spp. in 42.9%. In the multivariate analysis, independent factors significantly associated with candidaemia were Candida colonisation (OR = 4.12, 95% CI: 1.82-9.33), total parenteral nutrition (OR = 3.89, 95% CI: 1.73-8.78), elective surgery (OR = 2.75, 95% CI: 1.17-6.45) and haemofiltration procedures (OR = 1.96, 95% CI: 1.06-3.62). In the ICU setting in Spain and in patients who have stayed in units for >7 days, more than half of cases of candidaemia were caused by C. albicans. Risk factors for candidaemia identified included Candida colonisation, elective surgery, total parenteral nutrition and haemodialysis.     

Candida endocarditis: role of new antifungal agents

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans , and one pacemaker endocarditis was because of Candida parapsilosis . All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.     

Epidemiology and management of candidaemia--a retrospective, multicentre study in five hospitals in the UK

Candidaemia is associated with high mortality. Despite the fact that Candida species account for close to 10% of all nosocomial bloodstream infections, relatively few studies have investigated the management of candidaemia in hospitals. Our objective was to find out how candidaemia is managed in hospitals. Data relating to all episodes of candidaemia for the year 2008 were retrospectively collected in five centres in Scotland and Wales. A total of 96 candidaemic episodes were recorded in the year 2008, yielding 103 isolates of Candida. Fifty candidaemic episodes were caused by Candida albicans. Fluconazole was the most common agent prescribed for the treatment of candidaemia. There was great variation in the prescribed dose of fluconazole. Forty per cent of patients who survived received <2 weeks of systemic antifungal therapy. Central venous catheters (CVC) were removed in 57% of patients. CVC removal was not associated with better survival. The overall mortality was 40.4%. Management of candidaemia varies between the UK centres and is often inadequate. There is need to have consensus on the dosages of antifungal agents and the duration of therapy. The current guidance on removal of CVC in all cases of candidaemia should be reviewed.     

Epidemiology and prognosis of candidaemia in elderly patients

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy‐six episodes occurred in elderly patients (>75 years), 227 episodes in middle‐aged patients (61‐75 years) and 232 episodes in younger patients (16‐60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle‐aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30‐day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.     

Candidaemia in an Irish tertiary referral hospital: epidemiology and prognostic factors

There were two parts to this study. Part 1 evaluated the epidemiology of Candida bloodstream isolates within the Southern Health Board (SHB) of Ireland from 1992 to 2003 by retrospective surveillance of all such isolates of patients reported from SHB hospitals to our laboratory database during that period. Part 2 reviewed candidaemia cases occurring in Cork University Hospital (CUH) from 1999 to 2003 using surveillance of all positive blood culture isolates in CUH microbiology laboratory during the 5-year period. In part 1, 250 Candida bloodstream isolates were reported in the SHB over 12 years. There was a pattern of decreasing percentage of C. albicans with time. Whereas in part 2, 63 cases of candidaemia were identified in CUH from 1999 to 2003. Candida albicans constituted 50% of all isolates, while C. parapsilosis and C. glabrata accounted for 21.2% and 18.2% respectively. Average annual incidence rate was 0.48 episodes/1000 admissions and 0.70 episodes/10 000 patient-days. Vascular catheters were the commonest source of candidaemia (61.9%) followed by the urinary tract (12.7%). Risk factors included exposure to multiple antibiotics (75%); central vascular catheterization (73%); multiple colonization sites (71%); severe gastrointestinal (GI) dysfunction (54%) and acute renal failure (43%). Crude 7-day and 30-day mortality rates were 20.6% and 39.7% respectively. Logistic regression multivariate analysis identified the following to be independent predictors for mortality: age > or =65 years [odds ratio (OR) 7.2, P = 0.013]; severe GI dysfunction (OR 10.6, P = 0.01); acute renal failure (OR 7.6, P = 0.022); recent/concurrent bacteraemia (OR 5.2, P = 0.042); endotracheal intubation (OR 7.7, P = 0.014); while major surgery was associated with a better prognosis (OR 0.05, P = 0.002). Appropriate antifungal treatment was also found to be associated with survival (Fisher's exact test, P < 0.001). The epidemiology of Candida bloodstream isolates within our health board had changed over the years. Incidence and mortality of candidaemia were relatively high in our hospital. Dysfunction of major organ systems and recent bacteraemia were found to predict mortality.     

Persistent Fungemia - Risk Factors and Outcome in 40 Episodes

Abstract

The aim of this multicenter survey was to assess risk factors and mortality in patients with persistent fungemia (PF). Cases of persistent fungemia, defined as positive blood culture for at least 3 causative days of antifungal therapy were selected. Forty cases of persistent fungemia (lasting more than 3 days) were compared with 270 non-persistent fungemias appearing within the same period, and analyzed by univariate and multivariate analysis for risk factors and outcome. The median number of days of positive culture was 4.4 (3 - 20): 22 episodes were due to Candida albicans, 1 due to non-albicans Candida spp., 6 episodes due to non-Candida spp. Yeasts: 15 were catheter related, 16 patients had yeast-infected surgical wounds, 12 were neutropenic, 4 cases were caused by species resistant in vitro, 2 to amphotericin B (Trichosporon spp.) and 2 to fluconazole (C. laurentii, C. glabrata). Fifteen patients (37.5%) died, 7 of whom due to fungemia. Nineteen cases had one known risk factor (10 had infected wound, 4 infected vascular catheter, 3 were neutropenic and 2 had inappropriate therapy). Fourteen cases had two known risk factors (4 had wound and infected catheter, 4 neutropenia and infected catheter, 2 neu-tropenia and resistant organism, 4 other combinations. Two cases had 3 known risk factors and one had 4 risk factors for persistent fungemia. Artificial ventilation, C. glabrata etiology, non-Candida spp. yeasts such as Trichosporon spp. and Cryptococcus spp. and prior surgery were significantly associated with persistent fungemia in univariate, whereas only C. glabrata etiology in multivariate analysis. Breakthrough fungemia during empiric therapy with fluconazole was also observed more frequently in patients with persistent fungemia. However, there was no difference in both attributable and overall mortality between both groups.     

Microbial epidemiology of candidaemia in neonatal and paediatric intensive care units at the Children's Medical Center,Tehran

Invasive candidiasis is a major cause of morbidity and mortality in children. However, limited data are available on the epidemiology of this infection in paediatric settings in Iran. The aim of this study was to determine the prevalence, microbial epidemiology, risk factors and clinical outcomes associated with candidaemia in intensive care units at the Children's Medical Center, Tehran, Iran. All blood and other normally sterile specimen cultures positive for Candida species were included. Isolates were identified by morphological and molecular methods. Unidentified/doubtful yeast isolates were subjected to ITS sequencing. A total of 156 episodes of invasive candidiasis, with an overall incidence of 15.2 per 1000 ICU admissions, was recorded. Risk factors included presence of central venous lines (89.1%), mechanical ventilation (55.8%) and parenteral nutrition (51.3%). Candida albicans (57.1%) and Candida parapsilosis (24.4%) were the most commonly isolated species. Candida orthopsilosis, Candida glabrata, Candida dubliniensis, Candida lusitaniae, Candida kefyr and Candida intermedia accounted for about 11% of the cases. The overall mortality rate was 42.5%. Non‐albicans Candida species accounted for nearly half of the cases of paediatric candidaemia. This is the first prospective study of candidaemia in paediatric settings in Iran and serves to inform necessary interventions for the prevention of candidaemia.     

Primary isolation of Candida species from urine specimens using chromogenic medium

CHROMagar Candida (CaC) is a chromogenic medium that can be used to detect Candida species, including Candida albicans, Candida krusei, Candida tropicalis, and perhaps Candida glabrata. We evaluated the utility of CaC to detect candiduria in high-risk patients and the potential usefulness of this information in directing initial antifungal therapy in those later identified with candidaemia. CaC was compared in parallel to standard laboratory methods (SM) for the detection of Candida from urine collected from high-risk units and wards. Of 893 samples, Candida was recovered by CaC from 104 compared with 35 using SM. No isolates detected by SM were undetected by CaC. More than one Candida species were recovered by CaC in 19 of the 104 (18.3%); only two mixed cultures were detected by SM. The identification was more rapid with CaC. Five of 69 patients with candiduria detected by CaC developed candidaemia on or after the date of urine culture. SM recovered fungus in only two of these patients. CaC can be used as primary media for the detection of Candida species from urine specimens. Primary isolation by CaC may enable clinicians to make earlier, directed selection of antifungal agents and potentially reduce patient morbidity and mortality.     

Our 2014 approach to candidaemia

Candidaemia remains a relevant challenge in everyday patient care on intensive care units and general wards. Delays to adequate treatment increase mortality rates and institutional standard operating procedures facilitate optimal treatment. A positive blood culture requires immediate treatment. Echinocandins are the first‐line drugs of choice. Indwelling catheters have to be removed if feasible. Daily blood cultures until persistently negative exclude ongoing fungaemia. In case of Candida parapsilosis antifungal therapy should be switched to intravenous fluconazole. After 10 days of intravenous either echinocandin or fluconazole treatment, step‐down to oral application of fluconazole simplifies antifungal therapy. Depending on organ involvement and clinical presentation of the patient antifungal treatment should be continued for at least 14 days after the last positive blood culture. We present our institutional management algorithm for candidaemia which is based on current guidelines and recommendations to improve patient outcome.     

Candida endocarditis in neonates: report of five cases and review of the literature

Candidal endocarditis is an uncommon and serious complication of invasive Candida infection in neonates. The aim of this study was to further characterise candidal endocarditis in neonates. Between 1995 and 2000, 56 patients were diagnosed with Candida bloodstream infections (CBSI) in the Neonatal Intensive Care Unit of Schneider Children's Medical Center of Israel. Five of them (9%) developed mycetoma of the right atrium. None of the patients had congenital heart disease or a central venous catheter in the right heart at the time of diagnosis. All were treated with amphotericin B alone or in combination with other antifungals, without surgical intervention. One patient died of the disease and one died later of polymicrobial sepsis and necrotizing enterocolitis. A review of the literature since 1980 yielded an additional 25 cases of candidal endocarditis. For the whole sample (n = 30) survival rate was 73.1%. Six of the 10 patients treated with antifungal agents and surgery survived (60%), compared with 13 of the 20 patients treated only medically (65%) (P = 1.0). Candida endocarditis in neonates differs from fungal endocarditis in adults in risk factors, clinical presentation and outcome. As the outcome of surgical and medical treatment are comparable, antifungal therapy alone may be a valid therapeutic option in high-risk cases.     

Nosocomial candidaemia in children: results of a 9-year study

The aim of this study was to determine changes in the incidence of nosocomial candidaemia and to evaluate the risk factors, demographic features, treatment and clinical outcome associated with candidaemia in a Turkish tertiary care paediatric unit within a 9-year period. The data of children who were diagnosed as nosocomial candidaemia, were examined in this study. Between January 1997 and December 2005, a total of 102 nosocomial candidaemia episodes were identified in 102 patients. The rate of nosocomial candidaemia in our clinic increased from 3.2 cases per 1000 admissions in 1997–1999, to 5.5 per 1000 admissions in 2000–2002 and to 6.9 per 1000 admissions in 2003–2005 ( P  = 0.003). The species most frequently causing candidaemia were Candida albicans (39.2%), Candida parapsilosis (21.6%) and Candida tropicalis (15.7%). The mortality of C. albicans (37.5%), was significantly higher than the mortality of non- albicans species (17.7%) ( P  = 0.04). Independent risk factors associated with candidaemia-related deaths by logistic regression analysis were disseminated candidiasis (odds ratio, 5.7; P  = 0.01), paediatric intensive care unit stay (odds ratio, 8.1; P  = 0.001), prolonged antibiotics therapy (odds ratio, 5.2; P  = 0.014), use of total parenteral nutrition (odds ratio, 4.4; P  = 0.038) and mechanical ventilation (odds ratio, 4.9; P  = 0.01). The rate of nosocomial candidaemia in our clinic increased >2-fold during the study period.     

Observational study on candidaemia at a university hospital in southern Italy from 1998 to 2004

In an observational study on candidaemia in hospitalised patients, conducted in a southern Italy hospital during 1998-2004, 155 cases were noted. Candida albicans (CA) was isolated in 71 (45.8%) cases involving mainly patients recovered in ICU, General Surgery and Neonatology. Candida non-albicans (CnA) species were isolated by 84 (54.2%) candidaemic patients, and in particular, Candida parapsilosis was the most frequent species isolated in Pediatric Oncology. 91.6% of the patients had a central venous catheter and only 46.4% were receiving antifungal prophylaxis. Among these patients, 87.5% (63) developed CnA infections; in particular, 41 patients had a C. parapsilosis bloodstream infection. During our study, we observed a variable drift from 1998 to 2003; we registered an evident increment of CnA candidaemia (76.9%) and a decrease of CA cases (23%) only in 2004. The mortality was 26.7%, and we observed that CA was associated with the highest rate of mortality (53.6%). Although Candida infections are correlated primarily with risk factors, their resolution depends on timely diagnosis and early therapy.     

Epidemiology,species distribution,clinical characteristics and mortality of candidaemia in a tertiary care university hospital in Turkey, 2007‐2014

Candidaemia still continues to be a serious medical concern and the epidemiology of candidaemia varies according to geographical areas. We aim to determine the incidence, local epidemiology, Candida species distribution and crude mortality rates of candidaemia. We retrospectively evaluated candidaemia episodes in between January 2007 and August 2014. We compared demographic, clinical, microbiological findings and mortality rates of episodes caused by Candida albicans and non‐albicans Candida species. Overall the candidaemia incidences were 1.23 episodes/1000 admissions. A significant negative slope among candidaemia episodes and years was determined. Overall C. albicans (54.6%) was the most common species followed by Candida glabrata, Candida tropicalis and Candida parapsilosis respectively. Preinfection hospital stay and length of hospital stay were statistically longer in patients with non‐albicans Candida candidaemia than in patients with C. albicans candidaemia. The source of candidaemia was unknown in 52.5% of all episodes. Central venous catheters among non‐albicans Candida candidaemia episodes and urinary system among C. albicans candidaemia episodes were common source of candidaemia compared to each other. Previous antifungal therapy preceding candidaemia and concomitant bacteraemia were significantly associated with non‐albicans Candida candidaemia. Continuous local surveillance will preserve its pivotal importance in formulating empirical antifungal therapy and improving management of candidaemia.     

Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria

Candidaemia is the most common clinical presentation of invasive candidiasis and is a major cause of morbidity and mortality. Candiduria is a predictor for candidaemia; however, patient characteristics that are associated with concurrent candidaemia in the setting of candiduria are unclear. Identifying these characteristics could aid in the early detection of systemic disease. We performed a retrospective cohort analysis of hospitalised patients with candiduria at our institution over a 13‐year period. Our evaluation of patient characteristics included demographics, comorbidities, medications, procedures, devices, vital signs and laboratory values. We developed a multivariable logistic model to identify factors associated with candidaemia in patients with candiduria. We identified 4240 patients with candiduria, 263 (6.2%) of whom had candidaemia. Predictors for increased risk of candidaemia with candiduria included hospitalisations > 12 days, central venous catheter, parenteral nutrition, haematological and gynaecological malignancy, and receipt of β‐lactam/β‐lactamase inhibitors. Vital signs and laboratory values associated with candidaemia included elevated heart rate, temperature and creatinine, along with neutropenia and neutrophilia. Factors that demonstrated a decreased risk of candidaemia included diabetes mellitus, gastrostomy and urinary catheter with antibiotic use. The c‐statistic was 0.741 (95% CI, 0.710‐0.772). We identified a set of clinical characteristics that can predict the presence of candidaemia with candiduria.     

Risk factors and outcome for breakthrough candidaemia in patients with cancer

While candidaemia that develops during systemic antifungal prophylaxis or therapy [breakthrough (BT) candidaemia] has been reported increasingly, the risk factors and outcome of BT candidaemia are not yet known definitely. We evaluated a consecutive series of cancer patients with candidaemia at Asan Medical Center during 6 years to identify risk factors and outcome in BT candidaemia comparing with non-BT candidaemia. Fifty-four episodes of candidaemia in cancer patients diagnosed during this period were reviewed retrospectively. There were 10 episodes (18.5%) of BT candidaemia in which the species distribution and frequency of catheter-related infection in the BT and non-BT groups were similar. BT candidaemia had a tendency to occur more frequently in patients with haematological than non-haematological diseases. Profound neutropenia and disseminated candidiasis were more common in the BT group; however, these differences were not statistically significant (P = 0.17 and 0.07 respectively). The duration of prior antibiotic therapy and duration of profound neutropenia (<100 mm(-3)) were identified as risk factors for BT candidaemia (P < 0.01 and 0.02 respectively) in univariate analysis and the latter was the only risk factor in multivariate analysis. The death rates due to candidaemia were 85.7% in the BT group and 42.9% in the non-BT group (P = 0.08); however, BT candidaemia alone did not increase mortality rate.     

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

Culture‐based diagnosis of candidaemia suffers poor sensitivity and prolonged turnaround time. The 1,3‐beta‐D‐glucan (BDG) assay is a non‐culture‐based broad fungal antigen with rapid turnaround time. To assess overall, species‐specific and population‐specific sensitivity of the BDG assay for candidaemia, to determine if the BDG assay is able to detect candidaemia prior to blood culture collection, and to evaluate the performance of the assay for the detection of Candida auris candidaemia. A retrospective review of all blood cultures (BC) with C albicans, C parapsilosis, C glabrata, C krusei and C auris was performed. A corresponding BDG result (Fungitell^®) within 10 days of the BC was sought on the laboratory information system. Overall sensitivity of the assay was 79% (95% CI 73‐85; 173/218). Per species sensitivity was 81% (95% CI 72‐90; 66/81) for C albicans, 72% (61‐83; 60/83) for C parapsilosis, 90% (95% CI 79‐100; 27/30) for C glabrata, 71% (95% CI 43‐99; 10/14) C auris and 100% (10/10) for C krusei. No statistically significant difference in sensitivity between species was noted (P = .093). The assay demonstrated 92% (59/64) sensitivity in neonatal ICU (P = .047) compared to 94% (15/16) in surgery, 81% (59/73) in adult ICUs and 71% (15/21) in Oncology. BDG results were positive up to 10 days prior to blood culture collection with no significant difference in detection rate (P = .563). BDG results were positive up to 10 days prior to blood culture collection. BDG when collected a mean of 2.5 days (range 1‐10 days) prior to blood culture collection were positive.