title: Performance of Candida real-time polymerase chain reaction, β-D-glucan assay, and blood cultures in the diagnosis of invasive candidiasis.
abstract: 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.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pennsylvania 15261, USA. mhn5@pitt.edu
authors.forename: M Hong
authors.initials: MH
authors.lastname: Nguyen
authors.forename: Mark C
authors.initials: MC
authors.lastname: Wissel
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.forename: Martin A
authors.initials: MA
authors.lastname: Salomoni
authors.forename: Binghua
authors.initials: B
authors.lastname: Hao
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Press
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Shields
authors.forename: Shaoji
authors.initials: S
authors.lastname: Cheng
authors.forename: Dimitra
authors.initials: D
authors.lastname: Mitsani
authors.forename: Aniket
authors.initials: A
authors.lastname: Vadnerkar
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.forename: Steven B
authors.initials: SB
authors.lastname: Kleiboeker
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
mesh_terms: D002175:Candida / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D058387:Candidemia / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D002177:Candidiasis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D004271:DNA, Fungal / Q000097:blood* / Q000235:genetics; D006801:Humans; D011446:Prospective Studies; D011509:Proteoglycans; D011933:Reagent Kits, Diagnostic; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000097:blood*
chemical_list: D004271:DNA, Fungal; D011509:Proteoglycans; D011933:Reagent Kits, Diagnostic; D047071:beta-Glucans; C010770:polysaccharide-K