title: Value of β-D-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions.
abstract: OBJECTIVE
  To assess the value of (1→3)-β-D: -glucan (BDG), Candida albicans germ tube antibody (CAGTA), C-reactive protein (CRP), and procalcitonin (PCT) levels for the diagnosis of invasive candidiasis (IC) and for differentiating Candida spp. colonization from infection in ICU patients with severe abdominal conditions (SAC).
  
  
  METHODS
  Prospective study of 176 non-neutropenic patients, with SAC at ICU admission, and expected to stay at least 7 days. Surveillance cultures and BDG, CAGTA, CRP, and PCT levels were performed on the third day of ICU stay and twice a week for four consecutive weeks. Patients were grouped into invasive candidiasis (IC), Candida colonization, and neither colonized/nor infected. The classification and regression tree (CART) analysis was used to predict IC in colonized patients. The discriminatory ability of the obtained prediction rule was assessed by the area under the ROC curve (AUC).
  
  
  RESULTS
  The probabilities of IC were 59.3 % for the terminal node of BDG greater than 259 pg/mL and 30.8 % for BDG less than 259 pg/mL and CAGTA positivity, whereas there was a 93.9 % probability in predicting the absence of IC for BDG less than 259 pg/mL and negative CAGTA. Using a cutoff of 30 % for IC probability, the prediction rule showed 90.3 % sensitivity, 54.8 % specificity, 42.4 % positive predictive value, and 93.9 % negative predictive value with an AUC of 0.78 (95 % confidence interval 0.76-0.81). Significant differences in CRP (p = 0.411) and PCT (p = 0.179) among the studied groups were not found.
  
  
  CONCLUSIONS
  BDG with a positive test for CAGTA accurately differentiated Candida colonization from IC in patients with SAC, whereas CRP and PCT did not.
authors: Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014 Seville, Spain. cleong@telefonica.net
authors: Cristóbal
authors: C
authors: León
authors: Sergio
authors: S
authors: Ruiz-Santana
authors: Pedro
authors: P
authors: Saavedra
authors: Carmen
authors: C
authors: Castro
authors: Alejandro
authors: A
authors: Ubeda
authors: Ana
authors: A
authors: Loza
authors: Estrella
authors: E
authors: Martín-Mazuelos
authors: Armando
authors: A
authors: Blanco
authors: Vicente
authors: V
authors: Jerez
authors: Josep
authors: J
authors: Ballús
authors: Luis
authors: L
authors: Alvarez-Rocha
authors: Aránzazu
authors: A
authors: Utande-Vázquez
authors: Osvaldo
authors: O
authors: Fariñas
mesh_terms: D000368:Aged; D000908:Antibodies, Fungal / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002176:Candida albicans / Q000276:immunology* / Q000302:isolation & purification; D058387:Candidemia / Q000175:diagnosis*; D003663:Decision Trees; D004066:Digestive System Diseases / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D047071:beta-Glucans / Q000097:blood*
chemical_list: D000908:Antibodies, Fungal; C000606589:CALCA protein, human; D011498:Protein Precursors; D047071:beta-Glucans; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide