bloodstream infection in an immunocompromised host with discordant multiplex polymerase chain reaction and conventional blood culture results: a case report

Abstract

Prompt treatment of candidemia, especially in immunocompromised hosts, is known to improve outcomes. We present a case of discordance among results of Gram stain, multiplex polymerase chain reaction (PCR)-based rapid diagnostic technology, and conventional cultures that subsequently resulted in delayed therapy and hospitalization. An immunocompromised patient presented to the outpatient oncology clinic with signs and symptoms of systemic infection. Blood cultures were obtained, and Gram stain showed gram-negative rods, while multiplex PCR results (BioFire® FilmArray® BCID 1) returned positive for both Enterobacter cloacae and Candida parapsilosis . Conventional cultures only grew E. cloacae . Because of the discordant results, the primary team elected to give ertapenem monotherapy and defer antifungal therapy. The patient’s symptoms progressed, and 11 days later, the patient was admitted with subsequent positive blood cultures for C. parapsilosis . The patient required a 9-day hospitalization due to complications associated with candidemia. This case highlights the value of understanding and interpretation of rapid diagnostics, shared decision-making in antimicrobial management of high-risk patients, and the important responsibility of antimicrobial stewardship teams across the continuum of care.