Diagnostic value of bacterial and fungal blood cultures in patients with the acquired immunodeficiency syndrome.

PURPOSE

To evaluate the usefulness of bacterial and fungal blood cultures in febrile hospitalized patients with acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC).

PATIENTS AND METHODS

We reviewed all cases of bacteremia and fungemia detected in 446 patients admitted to a university hospital with AIDS or ARC over a 54-month period, and records of all patients with AIDS or ARC, with or without bacteremia, who were admitted during a 12-month subset of the study period.

RESULTS

Only four of the 28 cases of fungemia detected during the study period resulted in unique diagnoses of serious fungal infections, and all four patients died prior to discharge. Among the 46 cases of bacteremia diagnosed during the same period, all 36 (78%) with suggestive clinical findings were detected by culturing three times; nine of 10 without such findings were detected by culturing once and all by culturing twice. Medical record review of 132 patients admitted with AIDS or ARC during a 12-month subset of the study period revealed that culturing was common but the yield was low: positive culture rates were 1.9% for fungal cultures and 6.5% for bacterial cultures when clinical findings suggested bacteremia (versus 1.5% without such findings, p less than 0.025).

CONCLUSION

Fungal blood cultures had very little clinical value in the population studied, yielding unique diagnoses only in patients near death. In those with fever, but without clinical findings suggesting bacteremia, obtaining bacterial cultures on two occasions was sufficient to detect all cases.