Program Schedule

1434
Clinical Effectiveness of Fungal Blood Cultures: A 10-year Retrospective Analysis

Session: Poster Abstract Session: Diagnostic Microbiology: Viruses/Fungal/AFB/Parasitic
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Invasive fungal infections cause substantial morbidity and mortality. Fungal specific blood cultures have been proven effective in isolating fungal isolates but their clinical impact is unclear.  This study evaluates the clinical utility of fungal blood cultures in an integrated healthcare network of 22 hospitals over a 10 year period. 

Methods: Intermountain healthcare (IHC) has used the BACTEC MYCO/F Lytic fungal blood culture bottle in acute care settings for the past 10 years.  IHC’s electronic data warehouse was used to identify all fungal blood cultures performed from 2004 through 2013.  Results of standard blood cultures (BACTEC Plus Aerobic/F) performed within 7 days of fungal cultures were obtained for the same time period.   Positive fungal blood cultures were considered ‘matched’ if standard blood cultures grew the same organism or ‘unmatched’ if standard cultures were performed and did not grow the same organism.   

Results: From 2004 through 2013, 7,759 fungal blood cultures were performed.  Ordering of fungal blood cultures tripled from 407 cultures in 2004 to 1193 cultures in 2013.  Of the 7,759 fungal blood cultures, 97 were positive for fungal species (1.25%), representing 64 unique infection episodes; 42 matched cases and 22 unmatched cases.  Candida sp. made up similar amounts of matched and unmatched cases (86% and 90%, respectively).  Matched cases had on average more concomitant blood cultures performed (8.42 cultures vs 4.46 cultures, p < 0.01) within 7 days of the index fungal blood culture.  Unmatched Candida cultures were most likely due to sampling variation and not due to culture technique.  In the unmatched group, 3 infection episodes were due to non-Candida organisms; 1 was deemed a contaminant, 1 was identified via non-culture techniques, and 1 episode was identified with fungal blood culture. 

Conclusion: Over a 10 year period, we found that fungal blood cultures had little impact on clinical care and contributed to the management of only 1 patient.  Eliminating the use of fungal blood culture is unlikely to negatively impact patient care and would reduce healthcare cost.

Rosane Fernandez, MD1, Bert K. Lopansri, MD1,2, Kristin Dascomb, MD, PhD1,2, John Burke, MD2,3, Julia Shumway, MPH2 and Edward Stenehjem, MD MSc1,2, (1)Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, (2)Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (3)Internal Medicine, University of Utah School of Medicine, Salt Lake CIty, UT

Disclosures:

R. Fernandez, None

B. K. Lopansri, None

K. Dascomb, None

J. Burke, None

J. Shumway, None

E. Stenehjem, None

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