RT Journal Article
T1 Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions.
A1 León, Cristóbal
A1 Ruiz-Santana, Sergio
A1 Saavedra, Pedro
A1 Castro, Carmen
A1 Loza, Ana
A1 Zakariya, Ismail
A1 Úbeda, Alejandro
A1 Parra, Manuel
A1 Macías, Desirée
A1 Tomás, José Ignacio
A1 Rezusta, Antonio
A1 Rodríguez, Alejandro
A1 Gómez, Frederic
A1 Martín-Mazuelos, Estrella
A1 Cava Trem Study Group, 
K1 (1 → 3)-ß-D-glucan
K1 Anti-mannan antibody
K1 Candida PCR
K1 Candida albicans germ tube antibody
K1 Candida spp. colonization
K1 Candidemia
K1 Intra-abdominal candidiasis
K1 Invasive candidiasis
K1 Mannan antigen
AB To assess the performance of Candida albicans germ tube antibody (CAGTA), (1 → 3)-ß-D-glucan (BDG), mannan antigen (mannan-Ag), anti-mannan antibodies (mannan-Ab), and Candida DNA for diagnosing invasive candidiasis (IC) in ICU patients with severe abdominal conditions (SAC). A prospective study of 233 non-neutropenic patients with SAC on ICU admission and expected stay ≥ 7 days. CAGTA (cutoff positivity ≥ 1/160), BDG (≥80, 100 and 200 pg/mL), mannan-Ag (≥60 pg/mL), mannan-Ab (≥10 UA/mL) were measured twice a week, and Candida DNA only in patients treated with systemic antifungals. IC diagnosis required positivities of two biomarkers in a single sample or positivities of any biomarker in two consecutive samples. Patients were classified as neither colonized nor infected (n = 48), Candida spp. colonization (n = 154) (low-grade, n = 130; high-grade, n = 24), and IC (n = 31) (intra-abdominal candidiasis, n = 20; candidemia, n = 11). The combination of CAGTA and BDG positivities in a single sample or at least one of the two biomarkers positive in two consecutive samples showed 90.3 % (95 % CI 74.2-98.0) sensitivity, 42.1 % (95 % CI 35.2-98.8) specificity, and 96.6 % (95 % CI 90.5-98.8) negative predictive value. BDG positivities in two consecutive samples had 76.7 % (95 % CI 57.7-90.1) sensitivity and 57.2 % (95 % CI 49.9-64.3) specificity. Mannan-Ag, mannan-Ab, and Candida DNA individually or combined showed a low discriminating capacity. Positive Candida albicans germ tube antibody and (1 → 3)-ß-D-glucan in a single blood sample or (1 → 3)-ß-D-glucan positivity in two consecutive blood samples allowed discriminating invasive candidiasis from Candida spp. colonization in critically ill patients with severe abdominal conditions. These findings may be helpful to tailor empirical antifungal therapy in this patient population.
YR 2016
FD 2016-05-16
LK http://hdl.handle.net/10668/10081
UL http://hdl.handle.net/10668/10081
LA en
DS RISalud
RD Apr 7, 2025