Finding the “Missing 50%” of Invasive Candidiasis: How Nonculture Diagnostics Will Improve Understanding of Disease Spectrum and Transform Patient Care
Top Cited Papers
- 11 January 2013
- journal article
- review article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 56 (9), 1284-1292
- https://doi.org/10.1093/cid/cit006
Abstract
Blood cultures are limited for diagnosing invasive candidiasis by poor sensitivity and slow turn-around time. New diagnostics are needed to complement cultures, in particular to identify the “missing 50%” of patients who are blood culture-negative. Mannan/anti-mannan immunoglobulin G, β-D-glucan (BDG) and polymerase chain reaction (PCR) assays can diagnose candidemia before blood cultures and show promising sensitivity/specificity, but they are not widely investigated in blood culture–negative, deep-seated candidiasis. In a recent study, BDG and PCR were superior to blood cultures in deep-seated candidiasis, suggesting they may identify currently undiagnosed patients and expand our understanding of disease spectrum. Positive predictive values of nonculture tests are limited by the low prevalence of invasive candidiasis, which mandates that results be interpreted judiciously. When used as biomarkers that assess a patient's risk of having invasive candidiasis, tests will facilitate preemptive antifungal strategies. Because negative predictive values are excellent, tests will also be useful for ruling out invasive candidiasis and discontinuing unnecessary antifungal therapy.Keywords
This publication has 39 references indexed in Scilit:
- The end of an era in defining the optimal treatment of invasive candidiasis.Clinical Infectious Diseases, 2012
- Impact of Treatment Strategy on Outcomes in Patients with Candidemia and Other Forms of Invasive Candidiasis: A Patient-Level Quantitative Review of Randomized TrialsClinical Infectious Diseases, 2012
- Evaluation of a digital microfluidic real-time PCR platform to detect DNA of Candida albicans in bloodEuropean Journal of Clinical Microbiology & Infectious Diseases, 2012
- Quantitation of Candida CFU in Initial Positive Blood CulturesJournal of Clinical Microbiology, 2011
- Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: A multicenter, prospective, observational study in France (2005–2006)Critical Care Medicine, 2009
- Delaying the Empiric Treatment of Candida Bloodstream Infection until Positive Blood Culture Results Are Obtained: a Potential Risk Factor for Hospital MortalityAntimicrobial Agents and Chemotherapy, 2005
- The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistanceAmerican Journal Of Medicine, 1996
- Lysis—centrifugation blood cultures in the detection of tissue-proven invasive candidiasis disseminated versus single-organ infectionDiagnostic Microbiology and Infectious Disease, 1993
- Editorial Response: Should All Patients with Candidemia Be Treated with Antifungal Agents?Clinical Infectious Diseases, 1992
- Quantitative Blood Cultures in CandidemiaMayo Clinic Proceedings, 1991