DIAGN MICROBIOL INFECTDIS 103 1993;17:103-109 Lysis-Centrifugation Blood Cultures in the Detection of Tissue-Proven Invasive Candidiasis Disseminated versus Single-Organ Infection Juan Berenguer, Michael Buck, Frank Witebsky, Frida Stock, Philip A. Pizzo, and Thomas J. Walsh Several studies have demonstrated significantly higher fre- quency and more rapid detection of candidemia with blood cul- ture methods performed by lysis-centrifugation (LC) in com- parison with other techniques. Little is known, however, about the ability of LC blood culture methods to detect tissue-proven invasive candidiasis. We therefore investigated the sensitivity of LC blood cultures in the detection of tissue-proven invasive candidiasis. Between 1985 and 1991, invasive candidiasis was detected in 41 (5.1%) of 803 autopsies at the Clinical Center of the National Institutes of Health (Bethesda, MD, USA). Cases were classified as single-organ (SO) candidiasis (n = 20) and as disseminated candidiasis (DI) (n = 21). Patients with DI were more likely than those with SO to have a hema- tologic 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. When 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 cultures were positive in seven (78%) of nine patients with >3 organs in- fected by Candida in comparison to five (28%) of 18 patients with one organ 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 with DI and those with SO. These findings indicate that LC blood cultures are more likely to detect deeply invasive candidiasis in direct rela- tion to the number of tissue sites infected and that there is a critical need for development of more sensitive methods for de- tection of invasive candidiasis. INTRODUCTION Candida species have emerged as important noso- comial pathogens, particularly in compromised pa- tients. This has stimulated a considerable effort to understand better the pathogenesis, epidemiology, and clinical manifestations of candidiasis. This effort From the InfectiousDiseases Section(J.B., P.A.P., T.J.W.), Pediatric Branch, and the Department of Pathology(M.B.), Na- tional Cancer Institute; and the Microbiology Service (F.W., F.S.), ClinicalPathologyDepartment, Warren Grant Magnuson Clinical Center, Bethesda, Maryland, USA. Address reprint requests to Dr. T.J. Walsh, Infectious Diseases Section, National Cancer Institute, Building10, Room 13N-240, Bethesda, MD 20892, USA. Received 5 February 1993; revised and accepted 31 March 1993. © 1993ElsevierSciencePublishingCo., Inc. 655 Avenue of the Americas, New York, NY 10010 0732-8893/93/$6.00 has been paralleled by advances in the diagnosis and therapy of infections caused by these microorga- nisms (Walsh et al., 1992). The diagnosis of invasive candidiasis continues to be a major challenge, how- ever, in great part due to the lack of sensitivity and specificity of conventional culture-based diagnostic methods. During the last decade, the lysis-centrifugation (LC) blood culture system has been incorporated into many clinical laboratories. Several studies have dem- onstrated significantly higher frequency and more rapid detection of fungemia with LC in comparison with other blood culture systems (Bille et al., 1983a and b; Brannon and Kiehn, 1986; Buck et al., 1987; Dorn et al., 1979; Guerra-Romero et al., 1987; Kiehn et al., 1983; Murray, 1991). However, little is known about the correlation between tissue-proven inva-