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Diagnostic Performance of T2Candida Among ICU Patients With Risk Factors for Invasive Candidiasis.

Maiken Cavling Arendrup1,2,3, Jakob S Andersen4, Mads Kristian Holten5

  • 1Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark.

Open Forum Infectious Diseases
|May 10, 2019
PubMed
Summary

T2Candida combined with blood culture (BC) shows improved diagnostic performance for invasive candidiasis (IC) in high-risk ICU patients. This combination may enhance IC diagnosis despite modest individual test sensitivity.

Keywords:
Candidablood culturecandida mannan antigendiagnostic performanceintensive care unit

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Area of Science:

  • Clinical Microbiology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Invasive candidiasis (IC), encompassing candidemia and deep-seated infections, poses a significant threat in intensive care units (ICUs).
  • Blood culture (BC) remains the gold standard for IC diagnosis, but its low sensitivity often leads to delayed treatment.
  • Novel diagnostic methods like T2Candida offer potential improvements for early and accurate IC detection.

Purpose of the Study:

  • To evaluate and compare the diagnostic performance of T2Candida, BC, and Candida mannan antigen (MAg) for detecting IC in a high-risk ICU population.
  • To assess the utility of T2Candida in identifying specific Candida species relevant to IC.

Main Methods:

  • A prospective study included 126 high-risk ICU patients with sepsis despite antibiotic treatment.
  • Paired samples for BC, T2Candida, and MAg were collected twice weekly.
  • Patients were categorized into proven, likely, possible, or unlikely IC based on clinical review.

Main Results:

  • Fifteen percent of patients tested positive by at least one method; T2Candida detected more positive cases than BC or MAg individually.
  • T2Candida identified common pathogenic Candida species, aligning with BC or colonization isolates.
  • While individual test sensitivities were modest, combining T2Candida with BC increased sensitivity to 64-65% without compromising positive predictive value.

Conclusions:

  • All evaluated diagnostic tests demonstrated modest performance individually for invasive candidiasis detection.
  • The combination of T2Candida and BC exhibited superior diagnostic performance compared to individual tests.
  • Implementing T2Candida, particularly in conjunction with BC, holds promise for improving the diagnosis of invasive candidiasis in critically ill patients.