Eur J Clin Microbiol Infect Dis
DOI 10.1007/s10096-016-2781-y
ORIGINAL ARTICLE
Comparison of BACTEC™ blood culture media
for the detection of fungemia
R. Datcu 1 & J. Boel 1 & I. M. Jensen 1 & M. Arpi 1
Received: 7 July 2016 / Accepted: 5 September 2016
# Springer-Verlag Berlin Heidelberg 2016
Abstract The aim of the present study was to investigate
whether addition of the BACTEC™ Mycosis bottle to the
standard BACTEC™ aerobic and anaerobic bottles contribut-
ed to a higher detection rate and a faster time to detection
(TTD) of fungi. This was a retrospective cohort study of all
patients with a positive blood culture with Candida species
delivered to the Department of Clinical Microbiology, Herlev
and Gentofte Hospital, Denmark in the 8-year period 2006
through 2014. The patients had at least one BACTEC™ aer-
obic and one Mycosis bottle sampled at the same time and at
least one of the bottles yielded growth of fungi. Among 184
patients included, 173 were examined using BACTEC™ aer-
obic, anaerobic and Mycosis bottles. The anaerobic vial gen-
erally had the lowest detection rate and the longest TTD. The
detection rate of BACTEC™ aerobic plus anaerobic with the
BACTEC™ Mycosis bottle was significantly higher than the
detection rate of BACTEC™ aerobic plus anaerobic without
BACTEC™ Mycosis bottle for all species after 1–5 days, and
specially for Candida glabrata at 2, 3, 4 and 5 days. TTD for
C. glabrata was significantly shorter for BACTEC™ Mycosis
than TTD for BACTEC™ aerobic or anaerobic bottles after ½
to 4 days. When combining Bfirst or only^ detection, the
BACTEC™ Mycosis bottle had a significantly higher detec-
tion as compared to the aerobic bottle. Addition of the
Electronic supplementary material The online version of this article
(doi:10.1007/s10096-016-2781-y) contains supplementary material,
which is available to authorized users.
* R. Datcu
ralucadudau@yahoo.com
1
Department of Clinical Microbiology, Herlev and Gentofte Hospital,
University of Copenhagen, Herlev, Denmark
BACTEC™ Mycosis bottle to the standard BACTEC™ aer-
obic and anaerobic bottles significantly contributed to a higher
detection rate and a faster TTD of fungemia.
Introduction
Fungemia is a serious condition with high crude and attribut-
able mortality rates. Attributable mortality is defined as excess
mortality due to candidemia and it has been reported to vary
from 4.4 % to 49 % in randomized treatment trials [1, 2] and
up to 71 % in liver transplant patients [3]. In liver transplant
recipients the crude mortality rate was as high as 81 % [3].
More recent data about outcome of fungemia reported an
overall 30-day mortality of 47 % at an Italian Hospital [4],
while 30-day mortality decreased from 76.4 % (2003–2007)
to 60.8 % (2008–2012) for patients admitted to intensive care
units in 22 hospitals from Brazil [5]. The 30-day mortality was
31.5 % and did not differ significantly for oncological and
hematological cancer patients from 29 hospitals in Spain [6].
In a general Danish population with fungemia a 30-day mor-
tality rate of 37 % has been reported [7]. The incidence of
fungemia in Denmark is higher as compared to other Nordic
countries [8]. An increase in fungemic episodes with Candida
glabrata and Candida krusei was reported in Nordic countries
and globally and these species are known to be resistant to
fluconazole [5, 9–12]. This might be explained by a marked
increase of fluconazole consumption as has been reported in
Denmark [13]. A rapid species diagnosis and susceptibility
testing is important for survival of patients with fungemia.
The mortality of C. glabrata fungemia is significantly higher
if the initial empiric antifungal agent is fluconazole as com-
pared to caspofungin [8]. C. glabrata was significantly better
detected in blood using BacT/ALERT® (bioMérieux, France)
as compared to BACTEC™ (Becton Dickinson, USA) blood

culture media using two aerobic and two anaerobic media [8].
Herlev and Gentofte Hospital in Denmark has routinely used
two aerobic and two anaerobic BACTEC™ bottles for many
years. In 2006, we supplemented the routine aerobic and
anaerobic bottles with the BACTEC™ Mycosis bottle to
improve the diagnosis of fungemia in selected hospital
departments: Intensive Care Unit (ICU), Departments of
Hematology, Oncology, Nephrology, and Abdominal
Surgery. The Mycosis bottle contains a selective yeast medi-
um with two antibiotics (chloramphenicol, tobramycin), yeast
extract and sucrose, which inhibit bacterial growth and favor
the conditions for fungal growth.
Only a few publications have reported about the efficacy of
detection of fungi in the BACTEC™ system. The Mycosis
medium has been reported to have a higher detection rate
and a faster detection time than the BACTEC™ aerobic me-
dium [14].
The aim of the present study was to compare time to de-
tection (TTD) and detection rate of fungi in the BACTEC™
Mycosis, aerobic and anaerobic blood culture bottles in a
Danish adult population with fungemia.
Materials and methods
Study population
This was a retrospective cohort study of all patients with a
positive blood culture with Candida species delivered to the
Department of Clinical Microbiology (DCM), Herlev
Hospital, Denmark in the 8-year period from November
2006 to December 2014. DCM received blood cultures from
three hospitals in the Capital Region of Denmark (Herlev,
Gentofte and Glostrup Hospital). All hospitals have an ICU,
and Herlev Hospital also has specialized departments such as
hematology, oncology and nephrology/dialyse departments.
Under the entire study, the BACTEC™ system consisting of
aerobic, anaerobic and Mycosis bottles was used. Patients
were included if at least one aerobic and one Mycosis bottle
were taken at the same time from the same site and at least one
of the bottles yielded growth of fungi. Repeated findings of
the same yeast during an episode (≤30 days) of fungemia were
excluded. Blood culture bottles with polymicrobial growth of
yeasts and bacteria were excluded from the study as it could
have influenced the TTD. Children (<18 years) were not in-
cluded in the study.
Blood culture processing
Recommended blood volume was 8–10 ml for each bottle but
data regarding variations of blood volume were not recorded.
After collection, the blood culture bottles were transported to
DCM and incubated as fast as possible as any delay could
Eur J Clin Microbiol Infect Dis
negatively impact the TTD and positivity [15, 16]. Gentofte
and Glostrup Hospitals are about 10 and 8 kilometers away,
respectively, from Herlev Hospital, where the DCM is located.
The blood culture bottles could have been kept at room tem-
perature a few hours before sending from these two hospitals,
while time lag between collection of blood cultures and incu-
bation was much shorter for patients admitted to Herlev
Hospital. Bottles from the same set were simultaneously
placed into the incubator. Aerobic and anaerobic bottles were
incubated for 5 days, while the Mycosis bottle was incubated
for 14 days. When yeasts were observed by microscopy of
positive blood culture bottles, the culture media were supple-
mented with Sabouraud agar, which was incubated aerobical-
ly, at 35 °C until visible growth.
Statistical methods
Time to detection (TTD) was defined as the time from when
bottles were inoculated in the BACTEC™ unit until the system
detected growth. TTD was defined as: <½ day = <6 hours (h), ½
day = 6–18 h, 1 day =19–30 h, 1½ days = 31–42 h, 2 days = 43–
60 h, 3 days = 61–84 h, 4 days = 85–108 h, 5 days = 109–132 h
as previously published [17]. Detection rate was defined as the
percentage of positivity of each blood culture media.
BFirst or only^ evaluation was performed, and this ap-
proach was previously described [17]. This information was
provided by counting blood culture bottles where the isolate
was detected ≥ 6 h faster (Bfirst^) than in other bottles in the
set or was detected Bonly^ in that bottle in the set. Fischer’s
exact test was used for this comparison.
McNemar’s test was used for paired comparisons of TTD
between Mycosis, aerobic and anaerobic bottles taken at the
same time and from the same site. As negative aerobic and
anaerobic bottles were incubated for 5 days, and negative
Mycosis bottles for 14 days, comparison analyses were only
performed for the first 5 days of incubation. P-values < 0.05
were considered statistically significant. StatsDirect statistical
programme version 2.7.9 (2012) was used.
Results
A total of 184 patients were included in the study, 114 men
and 70 women. The age ranged between 40 and 93 years
(median 68 years). In the majority of patients (81 %) at least
two sets of BACTEC™ blood cultures were taken during an
episode of fungemia. Among the 184 patients included, 11
patients lacked BACTEC™ anaerobic bottles. The remaining
173 patients were examined using BACTEC™ aerobic, an-
aerobic and Mycosis bottles.
The species distribution of fungal isolates is presented in
Table 1. C. albicans (54 %), C. glabrata (18 %) and C. krusei
(15 %) were the most frequent species causing fungemia. Eleven
Eur J Clin Microbiol Infect Dis

Table 1 Distribution of fungal

isolates detected in blood cultures Yeast species Number of positive patients Percentage positive
from 184 patients in the 8-year per species (N) patients (%)
period November 2006 to
December 2014 C. albicans 99 53.8
C. glabrata 33 17.7
C. krusei 27 14.5
C. tropicalis 4 2.2
C. dubliniensis 4 2.2
C. famata 2 1.1
C. guilliermondii 2 1.1
C. lipolytica 1 0.6
Candida spp. 1 0.6
C. glabrata/C. albicans 3 1.6
C. glabrata/C. krusei 1 0.6
C. glabrata/C. tropicalis 1 0.6
C. famata/C. guilliermondii 2 1.1
C. tropicalis/C. albicans 1 0.6
Candida spp./C. palmioleophila 2 1.1
C. glabrata/C. lipolytica/C. albicans 1 0.6
Total 184 100

patients (6 %) had fungemia with two or three different Candida
species.
The BACTEC™ Mycosis bottle had a significantly higher
detection rate as compared to the BACTEC™ aerobic bottle
after incubation for 1 day (p < 0.05), 1 ½ days (p < 0.0001),
2 days (p < 0.05), 3 days (p < 0.05) and 5 days (p < 0.05). The
BACTEC™ anaerobic bottle had generally the lowest detec-
tion rate and the longest TTD (Table 2).
Fifty-one (29 %) isolates were detected in BACTEC™ anaer-
obic bottles with ≤ 120 h of incubation: 19 (37 %) C. albicans, 13
(25.5 %) C. krusei, 11 (21.5 %) C. glabrata, 3 (6 %) C. tropicalis
and 1 (2 %) C. guilliermondii. Four patients (8 %) with mixed
fungal blood stream infection were detected in the BACTEC™
anaerobic bottle. The median TTD (40.9 h) for the 11 isolates of
C. glabrata in the BACTEC™ anaerobic bottle was lower as
compared to the BACTEC™ aerobic bottle (median TTD =
120 h) but higher than the TTD in the BACTEC™ Mycosis
bottle (median TTD = 24 h).
When data were considered as binary with a TTD cutoff
=120 h, i.e. TTD was considered positive when TTD was ≤
120 h and negative when TTD > 120 h, C. glabrata was signif-
icantly more often detected in the BACTEC™ Mycosis bottle

Table 2 Paired comparisons (McNemar’s) between BACTECTM aerobic, anaerobic and Mycosis bottles for all patients

Time to detection Aerobic Mycosis Anaerobica p-value McNemar test

(TTD)
No. of positive No. of positive No. of positive Aerobic/Mycosis Anaerobic/Mycosis Aerobic/Anaerobic
bottles bottles bottles

Under ½ days 14 (13) 17 (15) (4) >0.05 <0.05 <0.05

½ days 50 (46) 59 (56) (8) >0.05 <0.0001 <0.0001
1 day 71 (65) 101 (96) (20) <0.05 <0.0001 <0.0001
1 ½ days 85 (77) 123 (115) (25) <0.0001 <0.0001 <0.0001
2 days 107 (98) 138 (128) (25) <0.05 <0.0001 <0.0001
3 days 119 (110) 145 (134) (26) <0.05 <0.0001 <0.0001
4 days 130 (120) 148 (137) (27) >0.05 <0.0001 <0.0001
5 days 167 (156) 149 (138) (113) <0.05 <0.05 <0.0001

Italic indicates the statistically significant p-values

No. of positive bottles is cumulative (cumulative no. of positives)
a
TTD is missing for 11 BACTECTM anaerobic vials, while TTD is registered for all aerobic and Mycosis (on 184 patients). These 11 patients are
excluded, leaving 173 patients. Data in brackets are cumulative number of positives included in McNemar’s test of BACTECTM anaerobic/Mycosis
bottles and aerobic/anaerobic bottles from 173 patients

than in the aerobic bottle (p < 0.05), while the differences were
not significant for C. albicans and C. krusei (Table 3).
Positivity of BACTEC™ aerobic plus anaerobic with the
BACTEC™ Mycosis bottle was significantly higher than pos-
itivity of BACTEC™ aerobic plus anaerobic without the
BACTEC™ Mycosis bottles for all species, but also distinctly
for C. glabrata at 2, 3, 4 and 5 days, while for C. krusei the
difference between detection rates was not statistically signif-
icant (Table 4).
No significant difference was found in the detection rate of
C. albicans between the BACTEC™ Mycosis bottle and the
BACTEC™ aerobic bottle from ≤ ½ day to 4 days, except at
1½ days where BACTEC™ Mycosis had a higher detection rate
(p < 0.05) (Table S1). After 5 days of incubation the detection
rate of C. albicans was higher for the BACTEC™ aerobic bottle
as compared to the BACTEC™ Mycosis bottle (p < 0.05).
The detection rate of C. glabrata was significantly higher for
the BACTEC™ Mycosis bottle than for the BACTEC™ aerobic
bottle after ½ to 4 days of incubation (p < 0.05). The TTD for
C. glabrata remained significantly shorter for the BACTEC™
Mycosis bottles than TTD for BACTEC™ aerobic or anaerobic
bottles after ½ to 4 days (Table S2). There were no statistically
significant differences in detection rate of C. glabrata between
BACTEC™ aerobic and anaerobic bottles (Table S2).
There were no statistically significant differences in TTD
for C. krusei between the BACTEC™ Mycosis bottle and the
BACTEC™ aerobic bottle (Table S3).
Among the 173 patients who delivered complete sets of
BACTEC™ aerobic, anaerobic and Mycosis, there were 127
from whom were taken two BACTEC™ aerobic, two anaerobic
and one BACTEC™ Mycosis, while from 31 patients one
BACTEC™ aerobic, one anaerobic and one BACTEC™
Mycosis were taken. The remaining 15 patients delivered either
one BACTEC™ aerobic and two anaerobic or delivered two
BACTEC™ aerobic and one anaerobic. Detection rates were
significantly higher for two BACTEC™ aerobic and two anaer-
obic plus one BACTEC™ Mycosis than without BACTEC™
Table 3 Paired comparisons (McNemar) between BACTECTM aerobic, anaerobic and Mycosis, when TTD is considered positive (TTD ≤ 120 hours)
and negative (TTD > 120 hours)
Species Aerobic Mycosis Anaerobic
No. of positive bottles No. of positive bottles No. of positive bottlesa Aerobic/Mycosis Anaerobic/Mycosis Aerobic/Anaerobic
All fungi 143 (133) 149 (138) (51)b
C. albicans 75 (72) 75 (71) (19)c
C. glabrata 22 (21) 31 (30) (11)d
C. krusei 23 (20) 20 (17) (13)e
Italic indicates the statistically significant p-values
No. of positive bottles is cumulative (cumulative no. of positives)
a
In brackets is the remaining number of patients as 11 BACTECTM anaerobic bottles (b ), four anaerobic bottles (c ), one anaerobic bottle (d ) and three
anaerobic bottles (e ), respectively, were missing. Those entire blood culture sets, missing anaerobic bottles were excluded, leaving 173 patients (all
patients), 95 patients (C. albicans), 32 patients (C. glabrata) and 24 patients (C. krusei), respectively.
Eur J Clin Microbiol Infect Dis
Mycosis at 1 ½ day, 2 days, 3 days, 4 days and 5 days. Detection
rates for one BACTEC™ aerobic and one anaerobic plus one
BACTEC™ Mycosis were significantly better than without
BACTEC™ Mycosis (Table S4).
Positive BACTEC™ Mycosis bottles were detected within
24 h in 77 (42 %) patients and within 48 h in 125 (68 %)
patients. Positive BACTEC™ aerobic bottles were detected
within 24 h in 57 (31 %) patients and within 48 h in 91
(49.5 %) patients. One hundred four (56.5 %) patients and
151(82 %) patients were detected using either BACTEC™
Mycosis or aerobic bottles within 24 h and 48 h, respectively.
Forty-six BACTEC™ aerobic, 85 BACTEC™ Mycosis
and four BACTEC™ anaerobic bottles detected yeasts Bfirst
or only^. The BACTEC™ Mycosis bottle had significantly
higher Bfirst or only^ detection as compared to the
BACTEC™ aerobic bottle (p < 0.001).
Discussion
This is the first Nordic study to compare the efficacy of the
BACTEC™ Mycosis and aerobic blood culture media to de-
tect fungemia. C. albicans was the dominating species causing
fungemia. As previously reported [10, 13], we found that
C. glabrata was the second most common cause of fungemia
in Danish patients with fungemia.
Especially C. glabrata had a higher detection rate in the
Mycosis bottle, and in general, the Mycosis bottle had a higher
detection rate of fungi. Furthermore, detection rate of fungi
was improved by adding BACTEC™ Mycosis to the initial
set of BACTEC™ aerobic plus anaerobic, as positivity of
BACTEC™ aerobic plus anaerobic with Mycosis was signif-
icantly higher than positivity of BACTEC™ aerobic plus an-
aerobic without BACTEC™ Mycosis.
The same results are reported in other studies, either per-
formed on simulated blood culture samples—bottles with
blood from sheep or humans inoculated with isolates of fungi
p-value McNemar
>0.05 <0.0001 <0.0001
>0.05 <0.0001 <0.0001
<0.05 <0.0001 <0.0001
>0.05 >0.05 >0.05
Eur J Clin Microbiol Infect Dis

Table 4 Comparison of detection

rate of BACTECTM aerobic plus Incubation time Positivity (%)
anaerobic without Mycosis versus
BACTECTM aerobic plus All yeastsa C. glabratab C. kruseic
anaerobic with Mycosis
Ae + An Ae + An + M Ae + An Ae + An + M Ae + An Ae + An + M

1 day 40 70** 9 72 71 75
1 ½ days 49 79** 22 84 75 79
2 days 60 92*** 25 94* 79 83
3 days 67 95*** 44 100** 79 83
4 days 73 98*** 59 100** 83 96
5 days 90 99*** 87 100** 92 96

Ae aerobic, An anaerobic, M Mycosis

a
Total of 173 patients from whom were taken complete sets of BACTECTM aerobic, anaerobic and Mycosis
b
Total of 32 patients from whom were taken complete sets of BACTECTM aerobic, anaerobic and Mycosis
c
Total of 24 patients from whom were taken complete sets of BACTECTM aerobic, anaerobic and Mycosis
*p < 0.05; **p < 0.001; ***p < 0.0001

[18, 19]—or on clinical samples [14, 19]. The detection rate of
the anaerobic bottles was low as compared to Mycosis and
aerobic bottles. However, we found that among 11 isolates of
C. glabrata detected within 120 h in the anaerobic bottles, six
TTDs were faster for anaerobic bottles than for aerobic bot-
tles; four TTDs were identical, while only one TTD was
slower. Faster TTD for C. glabrata were previously reported
in anaerobic bottles as compared to aerobic bottles from the
BACTEC™ system [20–23].
Thus, comparing TTD only between aerobic and Mycosis
could have potentially biased the results for detecting
C. glabrata. Therefore TTD was compared for aerobic or
anaerobic bottles versus Mycosis bottles. TTD remained sta-
tistically significantly improved for Mycosis bottles when
comparing with detection for aerobic or anaerobic bottles at
½ day, 1 day, 1 ½ day, 2 days, 3 days and 4 days.
Not only TTD was improved by using BACTEC™
Mycosis, but also the detection rate improved with a statisti-
cally significantly higher yield of C. glabrata when the
BACTEC™ Mycosis bottle was added to BACTEC™ aero-
bic and anaerobic bottles at 2, 3, 4 and 5 days.
When the approach was Bfirst or only^ comparison, the
Mycosis bottle had significantly higher Bfirst or only^ detec-
tion as compared to the aerobic bottle. This is an alternative
way to compare blood culture bottles, which is probably more
relevant for clinicians with respect to starting an appropriate
treatment.
Blood volume is an important parameter for positivity
of blood cultures and, generally, the higher the blood vol-
ume cultured the higher is sensitivity [24, 25]. This was
confirmed in the present study where two BACTEC™
aerobic and two anaerobic with one BACTEC™
Mycosis had significantly higher detection rate as those
without BACTEC™ Mycosis. The detection rate was also
significantly higher for one BACTEC™ aerobic and one
anaerobic with BACTEC™ Mycoses than for those with-
out BACTEC™ Mycosis bottle.
This study has both strengths and limitations. The strength
of this study is the great number of clinical blood cultures from
patients with fungemia, which is considered powerful enough
to draw reliable conclusions on detection rates and detection
times. Another strength is that every patient was included only
once and that repeated findings of the same fungal species
during a fungemic episode were excluded, as fungemic pa-
tients are blood cultured frequently to monitor the effect of
treatment according to the European guideline [26].
There are some limitations of the present study. We did not
routinely subculture negative blood culture bottles after the
incubation period. Therefore, we are not able to report about
false-negative results. Generally, a false-negative rate of 0.2 %
has been reported, when all microorganisms (both bacteria
and yeasts) were taken into consideration [20]. The advan-
tages of simulated samples are several: the blood volume,
inoculum and transportation time are standardized, antibiotic
status is known and a large variety of isolates can be inoculat-
ed. These features represent another limitation of our study. A
restricted number of yeast species was found, and
Cryptococcus neoformans, Fusarium sp., Saccharomyces
cerevisiae, C. parapsilosis were not among them. Only two
isolates of C. guilliermondii were found in the present study.
Conclusion
Addition of a BACTEC™ Mycosis bottle contributed to a
faster TTD and a higher detection rate of fungemia.
BACTEC™ Mycosis, aerobic and anaerobic bottles comple-
ment each other and it is recommended to use all three types of
bottles when fungemia is suspected.

Compliance with ethical standards
Conflict of interest The authors declare that they have no competing
interests.
Funding No funding was received for this work.
Ethics All procedures in the study were in accordance with the ethical
standards of institutional research committee and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards. For
this study, formal consent was not required as the study was retrospective.
References
1. Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-
Moya L, Smietana J, Lupinacci R, Sable C, Kartsonis N, Perfect J
(2002) Comparison of caspofungin and amphotericin B for invasive
candidiasis. N Engl J Med 347:2020–2029
2. Gudlaugsson O, Gillespie S, Lee K, Vande Berg J, Hu J, Messer S,
Herwaldt L, Pfaller M, Diekema D (2003) Attributable mortality of
nosocomial candidemia, revisited. Clin Infect Dis 37:1172–1177
3. Nieto-Rodriguez JA, Kusne S, Mañez R, Irish W, Linden P,
Magnone M, Wing EJ, Fung JJ, Starzl TE (1996) Factors associated
with the development of candidemia and candidemia-related death
among liver transplant recipients. Ann Surg 223:70–76
4. Bassetti M, Merelli M, Ansaldi F, De Florentiis D, Sartor A,
Scarparo C, Callegari A, Righi E (2015) Clinical and therapeu-
tic aspects of candidemia: A five year single centre study. PLoS
One 10:1–12
5. Colombo AL, Guimarães T, Sukienik T, Pasqualotto AC, Andreotti
R, Queiroz-Telles F, Nouér SA, Nucci M (2014) Prognostic factors
and historical trends in the epidemiology of candidemia in critically
ill patients: an analysis of five multicenter studies sequentially con-
ducted over a 9-year period. Intensive Care Med 40:1489–1498
6. Puig-Asensio M, Ruiz-Camps I, Fernández-Ruiz M, Aguado JM,
Muñoz P, Valerio M, Delgado-Iribarren A, Merino P, Bereciartua E,
Fortún J, Cuenca-Estrella M, Almirante B, Padilla B, Muñoz P,
Guinea J, Paño JR, García J, García C, Fortún J, Martín P, Gómez
E, Ryan P, Campelo C, de los Santos I, Buendía B, Pérez B, Alonso
M, Sanz F, Aguado JM, Merino P, González F, Gorgolas M, Gadea
I, Losa JE, Delgado-Iribarren A, Ramos A, Romero Y, Sánchez I,
Zaragoza O, Cuenca-Estrella M, Rodriguez-Baño J, Suarez AI,
Loza A, Aller AI, Martín-Mazuelos E, Ruiz M, Garnacho-
Montero J, Ortiz C, Chávez M, Maroto FL, Salavert M, Pemán J,
Blanquer J, Navarro D, Camarena JJ, Zaragoza R, Abril V, Gimeno
C, Hernáez S, Ezpeleta G, Bereciartua E, Hernández JL, Montejo
M, Rivas RA, Ayarza R, Planes A, Almirante B, J. Mensa J, Almela
M, Gurgui M, Sánchez-Reus F, Martinez-Montauti J, Sierra M,
Horcajada JP, Sorli L, Gómez J, Gené A, Urrea M (2015)
Epidemiology and outcome of candidaemia in patients with onco-
logical and haematological malignancies: Results from a
population-based surveillance in Spain. Clin Microbiol Infect 21:
491.e1–491.e10
7. Arendrup MC, Sulim S, Holm A, Nielsen L, Nielsen SD, Knudsen
JD, Drenck NE, Christensen JJ, Johansen HK (2011) Diagnostic
issues, clinical characteristics, and outcomes for patients with
fungemia. J Clin Microbiol 49:3300–3308
8. Arendrup MC, Fuursted K, Gahrn-Hansen B, Schønheyder HC,
Knudsen JD, Jensen IM, Bruun B, Christensen JJ, Johansen HK
(2008) Semi-national surveillance of fungaemia in Denmark 2004–
Eur J Clin Microbiol Infect Dis
2006: increasing incidence of fungaemia and numbers of isolates
with reduced azole susceptibility. Clin Microbiol Infect 14:487–494
9. Almirante B, Rodríguez D, Park BJ, Cuenca-Estrella M, Planes
AM, Almela M, Mensa J, Sanchez F, Ayats J, Gimenez M,
Saballs P, Fridkin SK, Morgan J, Rodriguez-Tudela JL, Warnock
DW, Pahissa A (2005) Epidemiology and predictors of mortality in
cases of Candida bloodstream infection: results from population-
based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin
Microbiol 43:1829–1835
10. Arendrup MC, Fuursted K, Gahrn-Hansen B, Jensen IM, Knudsen
JD, Lundgren B, Schønheyder HC, Tvede M (2005) Seminational
surveillance of fungemia in Denmark: notably high rates of
fungemia and numbers of isolates with reduced azole susceptibility.
J Clin Microbiol 43:4434–4440
11. Chen S, Slavin M, Nguyen Q, Marriott D, Playford EG, Ellis D,
Sorrell T (2006) Active surveillance for candidemia, Australia.
Emerg Infect Dis 12:1508–1516
12. Sandven P, Bevanger L, Digranes A, Haukland HH, Mannsaker T,
Gaustad P (2006) Candidemia in Norway (1991 to 2003): results
from a nationwide study. J Clin Microbiol 44:1977–1981
13. Arendrup MC, Bruun B, Christensen JJ, Fuursted K, Johansen HK,
Kjaeldgaard P, Knudsen JD, Kristensen L, Moller J, Nielsen L,
Rosenvinge FS, Roder B, Schonheyder HC, Thomsen MK,
Truberg K (2011) National surveillance of fungemia in Denmark
(2004 to 2009). J Clin Microbiol 49:325–334
14. Meyer MH, Letscher-Bru V, Jaulhac B, Waller J, Candolfi E
(2004) Comparison of mycosis IC/F and plus aerobic/F media
for diagnosis of fungemia by the Bactec 9240 System. J Clin
Microbiol 42:773–777
15. Kirn TJ, Weinstein MP (2013) Update on blood cultures: How
to obtain, process, report, and interpret. Clin Microbiol Infect
19:513–520
16. Morton B, Nagaraja S, Collins A, Pennington SH, Blakey JD
(2015) A retrospective evaluation of critical care blood culture
yield—Do support services contribute to the ‘weekend effect’?
PLoS One 10:1–10
17. Prag J, Nir M, Jensen J, Arpi M (1991) Should aerobic blood
cultures be shaken intermittently or continuously? APMIS 99:
1078–1082
18. Fricker-Hidalgo H, Chazot F, Lebeau B, Pelloux H, Ambroise-
Thomas P, Grillot R (1998) Use of simulated blood cultures to
compare a specific fungal medium with a standard microorgan-
ism medium for yeast detection. Eur J Clin Microbiol Infect Dis
17:113–116
19. Nawrot U, Kowalska-Krochmal B, Sulik-Tyszka B, Kozak M,
Świętek K, Pajączkowska M, Piątkowska E, Rosiak D, Swoboda-
Kopeć E (2015) Evaluation of blood culture media for the detection
of fungi. Eur J Clin Microbiol Infect Dis 34:161–167
20. Horvath LL, George BJ, Murray CK, Harrison LS, Hospenthal DR
(2004) Direct comparison of the BACTEC 9240 and BacT/ALERT
3D automated blood culture systems for candida growth detection. J
Clin Microbiol 42:115–118
21. Park BRG, Kim T, Kim HR, Lee M (2011) Comparative analysis
of simulated candidemia using two different blood culture sys-
tems and the rapid identification of Candida albicans. Ann Clin
Lab Sci 41:251–256
22. Hui M, Ho WH, Lam WH, Poon CS, Chu KC, Chan CY (2009)
Candida glabrata fungaemia: The importance of anaerobic blood
culture. J Med Microbiol 58:396–397
23. Foster N, Symes C, Barton R, Hobson R (2007) Rapid identifica-
tion of Candida glabrata in Candida bloodstream infections. J Med
Microbiol 56:1639–1643
24. Patel R, Vetter EA, Harmsen WS, Schleck CD, Fadel HJ,
Cockerill FR (2011) Optimized pathogen detection with 30-
compared to 20-milliliter blood culture draws. J Clin
Microbiol 49:4047–4051
Eur J Clin Microbiol Infect Dis
25. Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P
(2016) How to optimize the use of blood cultures for the diag-
nosis of bloodstream infections? A state-of-the art. Front
Microbiol 7:1–13
26. Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ,
Lortholary O, Meersseman W, Akova M, Arendrup MC, Arikan-
Akdagli S, Bille J, Castagnola E, Cuenca-Estrella M, Donnelly JP,
Groll AH, Herbrecht R, Hope WW, Jensen HE, Lass-Flörl C,
Petrikkos G, Richardson MD, Roilides E, Verweij PE, Viscoli C,
Ullmann AJ (2012) ESCMID* guideline for the diagnosis and
management of Candida diseases 2012: non-neutropenic adult pa-
tients. Clin Microbiol Infect 18:19–37