The value of fungal surveillance cultures as predictors of systemic fungal infections.

Fungal surveillance cultures consisting of urine, stool, and respiratory specimens were analyzed from 37 recipients of bone-marrow transplants and 52 patients undergoing chemotherapy for acute leukemia and other hematologic malignancies. All patients had prolonged aplasia. Sixty-seven percent of the patients were colonized by Candida albicans, and 28% were colonized by Candida tropicalis. No patient was colonized with any species of Aspergillus. There were 21 proven systemic fungal infections: three due to C. albicans, 16 due to C. tropicalis, and two due to Aspergillus. Positive surveillance data for C. tropicalis correlate with disease. Multiple positive-culture data yielded high predictive values (67%-83%), and single positive-culture data yielded slightly lower values as a function of body site. Positive surveillance data for C. albicans did not correlate with disease; negative culture data correlate with the absence of systemic disease due to C. tropicalis and C. albicans. Thus, surveillance data for specific fungal species can aid in diagnosis and appropriate therapy.