Fungemia and particularly candidemia are major infections in hospitals, especially in high risk departments, such as intensive care units (ICU), transplant and oncology units. In the USA, Candida spp. represented the fourth most common cause of nosocomial bloodstream infections from March 1995 to the end of September 2002 [1]. In France, recent data collected by the network for monitoring fungal infections (RESeau de Surveillance des Infections Fongiques, RESSIF) of the French National Reference Center for Invasive Mycoses and Antifungals showed that fungemia represents 49.3% of all invasive fungal infections (IFI), and that its incidence increased from 1.03 in 2012 to 1.19/10,000 in 2018 (p=0.0023) [2]. In a multicenter prospective cohort study in French ICUs, Candida spp. infections were the third most common cause of septic shock [3]. Moreover, a recent meta-analysis of candidemia in Europe found that the overall hospital incidence rate was 0.83/1,000 admissions per year, and the ICU incidence rate was 5.5/1,000 admissions per year [4]. The 30-day mortality rate was 37% for ICUs and 38% for tertiary hospitals. As mortality is influenced by the capacity to control the infection source and the time required to identify the optimal treatment, a rapid diagnosis of fungemia is essential [5], [6], [7].

Currently, blood cultures are the gold standard for the laboratory diagnosis of fungemia and bacteremia. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines recommend three blood cultures in a single session (divided in aerobic and anaerobic bottles), with a total volume of 40-60 mL blood for adults, and an incubation period of at least 5 days [8]. The BD BACTEC™ Mycosis IC/F culture vials and the BACTEC™ blood culture instrument (BD Diagnostic Systems, Sparks, MD, USA) are specific for growing fungi. This last vial type includes Brain Heart Infusion broth and Soybean-Casein Digest broth enriched with sucrose and yeast extract, and contains chloramphenicol and tobramycin to inhibit bacterial growth, and the lysis agent saponin. Few studies, using simulated blood or blood samples from patients, reported higher detection rate and faster detection time of fungal infections with the BD BACTEC™ Mycosis IC/F culture vials than with BD BACTEC™ aerobic and anaerobic culture vials [9], [10], [11], [12], [13]. However, only one study investigated their use for candidemia detection in patients receiving antifungal treatment compared with BACT/ALERT aerobic and anaerobic culture vials (bioMérieux, Marcy l'Etoile, France) [14].

At Nîmes University Hospital, France, BD BACTEC™ Mycosis IC/F vials have been used in departments at high risk of IFI (mainly hematology and ICU) since 2013. The aim of the present study was to compare standard blood culture vials (BD BACTEC™ Plus Aerobic/F and BD BACTEC™ Lytic Anaerobic/F culture vials) and BD BACTEC™ Mycosis IC/F culture vials for fungemia detection in patients receiving vs not receiving antifungal agents.