Aim: The significance of finding Candida species in heart blood cultures obtained at postmortem examination has never been studied. Therefore, we describe the findings of autopsy patients with postmortem candidemia and compare them to autopsy patients with antemortem candidemia.
Method: Twenty-three patients with Candida species isolated from heart blood at autopsy were identified over a ten-year period. These patients were compared to 10 autopsy patients found during the same time period with antemortem blood cultures isolating Candida species, but not positive postmortem heart blood cultures. Ante- and postmortem records were reviewed.
Results: All the 23 patients with Candida species isolated from postmortem blood culture all had one or more antemortem risk factors for disseminated candidiasis such as positive antemortem blood cultures, isolation of Candida from sterile internal sites, neutropenia, recent abdominal surgery, broadspectrum antibiotic administration or the use of central venous catheters or other invasive devices. Eight patients had histologic proof of invasive candidiasis in addition to the positive heart blood cultures. This group did not differ with respect to risk factors from 10 autopsy patients with disseminated candidiasis and antemortem blood cultures with Candida species. However, all the patients with antemortem candidemia had histologic evidence of disseminated candidiasis at autopsy.
Conclusion: Candidemia, when documented by heart blood culture performed at autopsy or by antemortem blood culture, is an insensitive, but highly specific indicator of disseminated candidiasis.