How do we diagnose Candidaemia? – Part 1
Blood CultureBlood culture remains the gold standard for the diagnosis of candidaemia but its sensitivity is considerably lower than in common bacteraemia due to low concentration of Candida in blood (up to 65% of positive blood cultures have <1 CFU/ml).
- A total of 60ml of blood needs to be collected within a 30-min period (three sets of 2x10ml) to achieve sensitivity of 50–75%
- Often takes 2-3 days to turn positive, final report available in 4-5 days
Antifungal Susceptibility TestingAntifungal susceptibility testing of Candida species may be done using standard platforms used for antibiotic susceptibility testing (VITEK).
- Antifungal susceptibility testing is available at the two national mycology reference laboratories (PHE and NHS), results are available in 3-4 days
Candida ScoreRecording the number of body sites colonised with Candida has been used to assess the risk for candidaemia (Candida score). However, it is important to understand that colonisation as such should not be treated with antifungals. Instead, it should trigger infection prevention measures such as changing urinary caterers (in case of high Candida counts in urine), change of lines (in case of heavy Candida growth around peripheral line) or improvement of oral hygiene/change of endotracheal tube (in case of heavy Candida growth in respiratory samples).
The Role of Antifungal Stewardship
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