Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study
Abstract Introduction 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, n...
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doaj-4094dd186d85498ba040f70c1c8095552020-11-25T03:33:37ZengAdis, Springer HealthcareInfectious Diseases and Therapy2193-82292193-63822019-05-018342944410.1007/s40121-019-0248-zPolymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM StudyMercedes Nieto0Juan Carlos Robles1Manuel Causse2Leticia Gutiérrez3Maria Cruz Perez4Ricard Ferrer5Mariona Xercavins6Eugenio Herrero7Elia Sirvent8Cristina Fernández9Paloma Anguita10Paloma Merino11the MICAFEM Study Group, GEIPC (SEIMC) and GTEIS (SEMICYUC)Hospital Clínico San CarlosHospital Reina SofíaHospital Reina SofíaHospital Universitario Son LlatzerHospital Universitario Son LlatzerCatlab-Hospital Universitari Mutua TerrassaCatlab-Hospital Universitari Mutua TerrassaHospital Universitario de TorreviejaHospital Universitario de TorreviejaHospital Clínico San CarlosAstellas Pharma Inc.Hospital Clínico San CarlosAbstract Introduction 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. Funding Astellas Pharma Inc.http://link.springer.com/article/10.1007/s40121-019-0248-zAbdominal fluidBlood culturesCandidaCandida diagnosisEmpirical antifungal treatmentInvasive candidiasis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mercedes Nieto Juan Carlos Robles Manuel Causse Leticia Gutiérrez Maria Cruz Perez Ricard Ferrer Mariona Xercavins Eugenio Herrero Elia Sirvent Cristina Fernández Paloma Anguita Paloma Merino the MICAFEM Study Group, GEIPC (SEIMC) and GTEIS (SEMICYUC) |
spellingShingle |
Mercedes Nieto Juan Carlos Robles Manuel Causse Leticia Gutiérrez Maria Cruz Perez Ricard Ferrer Mariona Xercavins Eugenio Herrero Elia Sirvent Cristina Fernández Paloma Anguita Paloma Merino the MICAFEM Study Group, GEIPC (SEIMC) and GTEIS (SEMICYUC) Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study Infectious Diseases and Therapy Abdominal fluid Blood cultures Candida Candida diagnosis Empirical antifungal treatment Invasive candidiasis |
author_facet |
Mercedes Nieto Juan Carlos Robles Manuel Causse Leticia Gutiérrez Maria Cruz Perez Ricard Ferrer Mariona Xercavins Eugenio Herrero Elia Sirvent Cristina Fernández Paloma Anguita Paloma Merino the MICAFEM Study Group, GEIPC (SEIMC) and GTEIS (SEMICYUC) |
author_sort |
Mercedes Nieto |
title |
Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study |
title_short |
Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study |
title_full |
Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study |
title_fullStr |
Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study |
title_full_unstemmed |
Polymerase Chain Reaction Versus Blood Culture to Detect Candida Species in High-Risk Patients with Suspected Invasive Candidiasis: The MICAFEM Study |
title_sort |
polymerase chain reaction versus blood culture to detect candida species in high-risk patients with suspected invasive candidiasis: the micafem study |
publisher |
Adis, Springer Healthcare |
series |
Infectious Diseases and Therapy |
issn |
2193-8229 2193-6382 |
publishDate |
2019-05-01 |
description |
Abstract Introduction 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. Funding Astellas Pharma Inc. |
topic |
Abdominal fluid Blood cultures Candida Candida diagnosis Empirical antifungal treatment Invasive candidiasis |
url |
http://link.springer.com/article/10.1007/s40121-019-0248-z |
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