Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences.
Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences.
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DOI：
10.3390/jof4010027
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发表时间：
2018-02-19
期刊：
影响因子：
--
通讯作者：
Nguyen MH
中科院分区：
文献类型：
--
作者：
Clancy CJ;Nguyen MH
血液培养阳性念珠菌分别在< 50%和< 20%的血源性播散性和腹腔内念珠菌病中呈阳性。非培养试验如甘露聚糖、抗甘露聚糖抗体、白色念珠菌生殖管抗体（CAGTA）、1,3-β-d-葡聚糖（BDG）、t2念珠菌纳米诊断面板和聚合酶链反应（PCR）可用于临床，但它们在患者护理中的作用尚不确定。甘露聚糖/抗甘露聚糖、BDG、T2Candida和PCR检测念珠菌的敏感性/特异性分别为~80%/80%、~80%/80%、~90%/98%和~90%/90%。腹腔内念珠菌病的有限数据显示，CAGTA、BDG的敏感性/特异性为~65%/75%，PCR敏感性为~ 85-90%。PCR对腹腔内念珠菌病的特异性差异很大（33-97%），缺乏t2念珠菌的数据。如果检测仅限于阳性和阴性预测值（ppv、npv）与检测前侵袭性念珠菌病可能性存在临床意义差异的病例，则检测将是有用的。在一些患者中，即使血培养呈阴性，ppv也足以证明抗真菌治疗是合理的。在大多数患者中，每项测试的npv都很好，这可能支持拒绝抗真菌治疗的决定。如果检测结果解释不明智，非培养诊断可能会对管理和感染预防计划产生意想不到的后果。特别是，不同的非培养试验阳性/培养阴性结果可能促使不太可能患有念珠菌病的患者接受不适当的抗真菌治疗，并导致虚假的医院获得性感染报告。总之，非培养念珠菌诊断有可能促进患者护理，但只有当用户了解检测的优势和局限性，并积极计划如何最好地在医院使用它们时，这一承诺才能实现。
Blood cultures are positive for Candida species in < 50% and < 20% of hematogenously disseminated and intra-abdominal candidiasis, respectively. Non-culture tests such as mannan, anti-mannan antibody, Candida albicans germ tube antibody (CAGTA), 1,3-β-d-glucan (BDG), the T2Candida nanodiagnostic panel, and polymerase chain reaction (PCR) are available for clinical use, but their roles in patient care are uncertain. Sensitivity/specificity of combined mannan/anti-mannan, BDG, T2Candida and PCR for candidemia are ~80%/80%, ~80%/80%, ~90%/98%, and ~90%/90%, respectively. Limited data for intra-abdominal candidiasis suggest CAGTA, BDG sensitivity/specificity of ~65%/75% and PCR sensitivity of ~85–90%. PCR specificity has varied widely for intra-abdominal candidiasis (33–97%), and T2Candida data are lacking. Tests will be useful if restricted to cases in which positive and negative predictive values (PPVs, NPVs) differ in a clinically meaningful way from the pre-test likelihood of invasive candidiasis. In some patients, PPVs are sufficient to justify antifungal treatment, even if blood cultures are negative. In most patients, NPVs of each test are excellent, which may support decisions to withhold antifungal therapy. If test results are not interpreted judiciously, non-culture diagnostics may have unintended consequences for stewardship and infection prevention programs. In particular, discrepant non-culture test-positive/culture-negative results may promote inappropriate antifungal treatment of patients who are unlikely to have candidiasis, and lead to spurious reporting of hospital-acquired infections. In conclusion, non-culture Candida diagnostics have potential to advance patient care, but this promise will be realized only if users understand tests’ strengths and limitations, and plan proactively for how best to employ them at their hospitals.
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DOI：
10.1093/cid/civ707
发表时间：
2015-12-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Knitsch W;Vincent JL;Utzolino S;François B;Dinya T;Dimopoulos G;Özgüneş İ;Valía JC;Eggimann P;León C;Montravers P;Phillips S;Tweddle L;Karas A;Brown M;Cornely OA
通讯作者：
Cornely OA
影响因子：
168.9
作者：
CALANDRA, T;SCHNEIDER, R;FRANCIOLI, P
通讯作者：
FRANCIOLI, P
影响因子：
5.2
作者：
Fortun, J.;Meije, Y.;Cuenca-Estrella, M.
通讯作者：
Cuenca-Estrella, M.
影响因子：
8.8
作者：
León, C;Ruiz-Santana, S;León, MA
通讯作者：
León, MA
DOI：
10.1186/cc12569
发表时间：
2013-03-18
期刊：
Critical care (London, England)
影响因子：
--
作者：
Hall AM;Poole LA;Renton B;Wozniak A;Fisher M;Neal T;Halloran CM;Cox T;Hampshire PA
通讯作者：
Hampshire PA