LYSIS CENTRIFUGATION BLOOD CULTURES IN THE DETECTION OF TISSUE-PROVENINVASIVE CANDIDIASIS - DISSEMINATED VERSUS SINGLE-ORGAN INFECTION

Several studies have demonstrated significantly higher frequency and m ore rapid detection of candidemia with blood culture methods performed by lysis-centrifugation (LC) in comparison with other techniques. Lit tle is known, however, about the ability of LC blood culture methods t o detect tissue-proven invasive candidiasis. We therefore investigated the sensitivity of LC blood cultures in the detection of tissue-prove n invasive candidiasis. Between 1985 and 1991, invasive candidiasis wa s detected in 41 (5.1%) of 803 autopsies at the Clinical Center of the National Institutes of Health (Bethesda, MD, USA). Cases were classif ied as single-organ (SO) candidiasis (n = 20) and as disseminated cand idiasis (DI) (n = 21). Patients with DI were more likely than those wi th SO to have a hematologic malignancy (71% vs 15%, P < 0.001) and to have gastrointestinal mucosal candidiasis (76% vs 25%, P = 0.003). LC detected fungemia in 16 (43%) of all 37 cases with blood cultures. Whe n analyzed by classification, Candida spp. were isolated from blood in 11 (58%) of 19 patients with DI and in five (28%) of 18 patients with SO (P = 0.13). When analyzed by number of organs infected, blood cult ures were positive in seven (78%) of nine patients with > 3 organs inf ected by Candida in comparison ta five (28%) of 18 patients with one o rgan infected (P = 0.024). The mean recovery time for Candida in blood cultures was 2.6 days in DI and 3.2 days in SO (P = 0.017). There was no difference in colonies of organisms per LC tube between patients w ith DI and those with SO. These findings indicate that LC blood cultur es are more likely to detect deeply invasive candidiasis in direct rel ation to the number of tissue sites infected and that there is a criti cal need for development of more sensitive methods for detection of in vasive candidiasis.