The incidence of fungal infections has been increasing for the last 3 decades, especially among neutropenic, cancer, and critically ill patients. These infections are associated with high mortality rates. We retrospectively reviewed medical charts of adult patients with fungemia from 1989 to 2000 at our institution. The characteristics of the population groups served by the hospital were described. Of 328 patients with fungemia, we reviewed 315 (96%) medical records, and focused on those with candidemia (n = 294). The species distribution in patients with candidemia showed that the most commonly identified species were Candida albicans (66%), followed by C. glabrata (17%), and C. parapsilosis (6%). The incidence of candidemia ranged from 0.2 to 0.46 per 10,000 patient-days with the highest incidence in 1993 and the lowest in 1997. Although most studies show an increased incidence of candidemia, we observed a reduction over the study period. Furthermore, we observed no shift from C. albicans to non-albicans Candida species despite a significant increase in the use of fluconazole. The overall mortality among patients with candidemia was 44%, with the highest rate in patients over 65 years (52%). Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer.

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Cytomegalovirus (CMV) DNA amplification assays in plasma have shown limited sensitivity compared to the detection of pp65 antigen in leukocytes. Our goal was to increase the sensitivity of a commercial CMV DNA PCR quantitative assay. After modification, the new assay was able to reproducibly detect 20 CMV DNA copies/ml of plasma. We compared this new ultrasensitive PCR assay with the standard PCR and the pp65 test for CMV detection and quantification in 22 consecutive allogeneic hematopoietic stem cell recipients. CMV infection or reactivation was detected in 84 of 319 (26%) samples by the ultrasensitive PCR assay compared to 38 of 319 (12%) samples by the pp65 assay (P < 0.01). All samples positive by the pp65 assay were positive by the ultrasensitive PCR, and CMV episodes were detected on average 4 days earlier and 7 days later than the first and the last pp65-positive test, respectively. In addition, during CMV episodes, the ultrasensitive assay identified positive samples that were inconsistently detected by the pp65 assay. The ultrasensitive assay was also much more sensitive than the standard PCR, with 26 versus 12% of CMV DNA-positive samples (P < 0.01). This assay improved the monitoring of CMV infection or reactivation in hematopoietic allogeneic stem cell recipients.Cytomegalovirus (CMV) is a leading cause of infection in allogeneic hematopoietic stem cell transplant patients. Preemptive therapy with ganciclovir or foscarnet is the most commonly used strategy to prevent CMV disease or complications, but it requires close quantification of the CMV load. Available methods for the detection and monitoring of the CMV load include the quantification of the pp65 antigen in blood leukocytes and CMV DNA amplification. The pp65 antigen assay remains a reference method and has been validated in several clinical trials (7,9,11,15). The assay has several drawbacks, including its limited sensitivity for leukopenic hematopoeitic stem cell recipients and the labor-intensive procedures. CMV DNA amplification assays in the format of a quantitative plasma-based PCR have the potential for higher sensitivity, and they are not dependent on the leukocyte count. Another potential advantage is that plasma can easily be stored before being processed. However, in previous reports, plasma-based PCR assays were either not standardized or displayed limited sensitivity compared to whole-blood PCR or the pp65 assay (1, 13).Our goal was to increase the sensitivity of a standardized plasma-based PCR assay, the Cobas Amplicor CMV Monitor test (Roche Diagnostic Systems, Inc., Branchburg, N.J.). The new ultrasensitive format showed ϳ20-fold-increased sensitivity. After validation, we assessed whether this ultrasensitive PCR could improve the monitoring of the CMV load in allogeneic hematopoietic stem cell transplant patients. We compared the performance of the ultrasensitive PCR to that of the routinely used pp65 antigen assay and to that of the standard Amplicor CMV Monitor test. MATERIALS AND METHODSConsecutive and unselected allogenei...