Title: Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Journal Article · · Frontiers in Microbiology
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Background Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill patients. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting Candida DNA in peritoneal fluids (PF) is useful in diagnosing and management of IAC in high-risk patients in intensive care unit (ICU). Methods A prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1–3)-β-D-glucan were performed in all patients. For Candida PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8 s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria. Results Among 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the Candida PCR assay were 64.7 and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63–0.91). In this cohort, the positive predictive value and negative predictive value were 90.8% (95% CI: 80.3–96.2%) and 61.1% (95% CI: 36.1–81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529, p  < 0.001) according to the 2013 European consensus criteria. Conclusion Detection of Candida DNA in PF using PCR can be considered an adjunct to existing routine diagnostic tools which may optimize the diagnosis and antifungal treatment of IAC in high-risk patients in the ICU.

Sponsoring Organization:
USDOE Office of Electricity (OE), Advanced Grid Research & Development. Power Systems Engineering Research
OSTI ID:
1907910
Journal Information:
Frontiers in Microbiology, Journal Name: Frontiers in Microbiology Vol. 13; ISSN 1664-302X
Publisher:
Frontiers Media SACopyright Statement
Country of Publication:
Switzerland
Language:
English

References (21)

Caspofungin for prevention of intra-abdominal candidiasis in high-risk surgical patients journal January 2009
A research agenda on the management of intra-abdominal candidiasis: results from a consensus of multinational experts journal October 2013
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 journal January 2017
ESICM/ESCMID task force on practical management of invasive candidiasis in critically ill patients journal March 2019
Appropriate Source Control and Antifungal Therapy are Associated with Improved Survival in Critically Ill Surgical Patients with Intra-abdominal Candidiasis journal January 2020
Association between source control and mortality in 258 patients with intra-abdominal candidiasis: a retrospective multi-centric analysis comparing intensive care versus surgical wards in Spain journal September 2016
Deciphering the epidemiology of invasive candidiasis in the intensive care unit: is it possible? journal June 2021
Jávea consensus guidelines for the treatment of Candida peritonitis and other intra-abdominal fungal infections in non-neutropenic critically ill adult patients journal July 2017
Performance of Candida Real-time Polymerase Chain Reaction,  -D-Glucan Assay, and Blood Cultures in the Diagnosis of Invasive Candidiasis journal March 2012
Finding the “Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care journal January 2013
Clinical validation of a multiplex real-time PCR assay for detection of invasive candidiasis in intensive care unit patients journal June 2014
Detection of fungal DNA in peritoneal fluids by a PCR DNA low-density microarray system and quantitation of serum (1-3)- -D-glucan in the diagnosis of peritoneal candidiasis journal December 2014
Roles of the multiplex real-time PCR assay and β-D-glucan in a high-risk population for intra-abdominal candidiasis (IAC) journal December 2019
Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: A multicenter, prospective, observational study in France (2005–2006) journal May 2009
PCR Diagnosis of Invasive Candidiasis: Systematic Review and Meta-Analysis journal February 2011
Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis journal January 2013
Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions journal May 2016
Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study journal September 2015
Molecular identification and antifungal susceptibility pattern of Candida species isolated from HIV infected Patients with candisiasis journal March 2019
Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences journal February 2018
Invasive candidiasis as a cause of sepsis in the critically ill patient journal August 2013

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