Performance of candida real-time polymerase chain reaction, β-D-glucan assay, and blood cultures in the diagnosis of invasive candidiasis

摘要

Background. The sensitivity of blood cultures for diagnosing invasive candidiasis (IC) is poor. Methods. We performed a validated Candida real-time polymerase chain reaction (PCR) and the Fungitell 1,3-β-D-glucan (BDG) assay on blood samples collected from prospectively identified patients with IC (n = 55) and hospitalized controls (n = 73). Patients with IC had candidemia (n = 17), deep-seated candidiasis (n = 33), or both (n = 5). Controls had mucosal candidiasis (n = 5), Candida colonization (n = 48), or no known Candida colonization (n = 20). Results. PCR using plasma or sera was more sensitive than whole blood for diagnosing IC (P =. 008). Plasma or sera PCR was more sensitive than BDG in diagnosing IC (80% vs 56%; P =. 03), with comparable specificity (70% vs 73%; P =. 31). The tests were similar in diagnosing candidemia (59% vs 68%; P =. 77), but PCR was more sensitive for deep-seated candidiasis (89% vs 53%; P =. 004). PCR and BDG were more sensitive than blood cultures among patients with deep-seated candidiasis (88% and 62% vs 17%; P =. 0005 and. 003, respectively). PCR and culture identified the same Candida species in 82% of patients. The sensitivity of blood cultures combined with PCR or BDG among patients with IC was 98% and 79%, respectively. Conclusions. Candida PCR and, to a lesser extent, BDG testing significantly enhanced the ability of blood cultures to diagnose IC.