• M Hong Nguyen, Mark C Wissel, Ryan K Shields, Martin A Salomoni, Binghua Hao, Ellen G Press, Ryan M Shields, Shaoji Cheng, Dimitra Mitsani, Aniket Vadnerkar, Fernanda P Silveira, Steven B Kleiboeker, and Cornelius J Clancy.
• Department of Medicine, University of Pittsburgh, Pennsylvania 15261, USA. mhn5@pitt.edu
• Clin. Infect. Dis. 2012 May 1; 54 (9): 1240-8.

BackgroundThe sensitivity of blood cultures for diagnosing invasive candidiasis (IC) is poor.MethodsWe 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).ResultsPCR 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.ConclusionsCandida PCR and, to a lesser extent, BDG testing significantly enhanced the ability of blood cultures to diagnose IC.

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