Sistema de Salut de Catalunya
Institut Català de la Salut
[Nieto M] Hospital Clínico San Carlos, Madrid, Spain. [Robles JC, Causse M] Hospital Reina Sofía, Córdoba, Spain. [Gutiérrez L, Cruz Perez M] Hospital Universitario Son Llatzer, Palma de Mallorca, Spain. [Ferrer R] Catlab-Hospital Universitari Mutua Terrassa, Barcelona, Spain. Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Vall d'Hebron Barcelona Hospital Campus
2019-07-16T05:35:48Z
2019-07-16T05:35:48Z
2019-05-24
Abdominal fluid; Blood cultures; Candida
Fluid abdominal; Hemocultiu; Candida
Fluido abdominal; Hemocultivo; Candida
We evaluated the diagnostic reliability of serum polymerase chain reaction (PCR) versus blood culture, abdominal fluid or both (composite measure) in patients receiving empirical antifungal treatment for suspected invasive candidiasis. METHODS: This observational, prospective, non-interventional, multicentre study in Spain enrolled 176 critically ill patients admitted to the intensive care unit. Separate blood samples for culture and serum PCR were taken before the start of antifungal therapy. Patient assessment was performed according to each site's usual clinical practice. The primary end point was concordance between serum PCR and blood culture. Secondary end points were concordance between serum PCR and a positive abdominal fluid sample or the composite measure. Quality indices included sensitivity, specificity, positive/negative predictive values (PPV/NPV) and kappa indices. RESULTS: Among 175 evaluable patients, rates of Candida detection were similar for serum PCR (n = 16/175, 9.1%) versus blood culture (n = 14/175, 8.0%). Quality indices for serum PCR relative to blood culture were: sensitivity 21.4%; specificity 91.9%; PPV 18.8%; NPV 93.1%; kappa index 0.125. Thirty-two abdominal fluid samples were positive. Quality indices for serum PCR versus abdominal fluid were: sensitivity 31.3%; specificity 83.0%; PPV 15.6%; NPV 92.3%; kappa index 0.100. Quality indices for serum PCR versus the composite measure were: sensitivity 15.8%; specificity 92.7%; PPV 37.5%; NPV 79.9%; kappa index 0.107. CONCLUSION: The sensitivity of serum PCR for Candida detection was low and the rate of concordance was low between serum PCR and the other diagnostic techniques used to identify Candida infections. Hospital-based diagnostic tests need optimising to improve outcomes in patients with suspected invasive candidiasis.
123/Astellas Pharma Global Development
Article
Published version
English
Candidiasis - Diagnòstic; Reacció en cadena de la polimerasa; Sang - Anàlisi; DISEASES::Bacterial Infections and Mycoses::Mycoses::Candidiasis::Candidiasis, Invasive; Other subheadings::Other subheadings::/diagnosis; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Genetic Techniques::Nucleic Acid Amplification Techniques::Polymerase Chain Reaction; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Clinical Laboratory Techniques::Microbiological Techniques::Blood Culture; ENFERMEDADES::infecciones bacterianas y micosis::micosis::candidiasis::candidiasis invasiva; Otros calificadores::Otros calificadores::/diagnóstico; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::técnicas genéticas::técnicas de amplificación de ácidos nucleicos::reacción en cadena de la polimerasa; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::técnicas de laboratorio clínico::técnicas microbiológicas::hemocultivo
Springer
Infectious Diseases and Therapy;
https://link.springer.com/article/10.1007%2Fs40121-019-0248-z
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
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