Clinical validation of a multiplex real-time PCR assay for detection of invasive candidiasis in intensive care unit patients
Clinical validation of a multiplex real-time PCR assay for detection of invasive candidiasis in intensive care unit patients
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DOI：
10.1093/jac/dku225
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发表时间：
2014-11-01
影响因子：
5.2
通讯作者：
Cuenca-Estrella, M.
中科院分区：
文献类型：
--
作者：
Fortun, J.;Meije, Y.;Cuenca-Estrella, M.
新技术，例如基于多重定量实时 PCR (MRT-PCR) 的技术，可以改善侵袭性念珠菌病 (IC) 的检测。我们前瞻性研究了 63 名重症监护病房疑似 IC 患者和 40 名健康对照者。所有患者在第0天和+2、+7、+14和+21天进行血培养和MRT-PCR。此外，还对 β-d-葡聚糖 (BDG) 和白色念珠菌芽管抗体 (CAGTA) 进行了定量。27 名患者确诊为 IC。 IC 患者的定植率显着较高（96% 与 64%，PaEuroS=aEuroS0.002）。 MRT-PCR诊断IC的敏感性、特异性、阳性预测值和阴性预测值分别为96.3%、97.3%、92.8%和98.7%。 MRT-PCR 的阳性预测值和特异性显着高于 BDG 和 CATGA。 MRT-PCR 表现非常好，特别是在深层 IC 中（灵敏度为 90.9%，血培养为 45.4%；PaEuroS=aEuroS0.06）。至于最适合 DNA 扩增的临床样本，在这项研究中，全血和血清呈现出相似的结果。MRT-PCR 似乎是确认危重患者（尤其是患有深部疾病的患者）IC 诊断的有用测试。其高灵敏度和阳性预测值使其成为比其他诊断程序和临床评分更有效的 IC 管理工具。
New techniques, such as those based on multiplex quantitative real-time PCR (MRT-PCR), can improve the detection of invasive candidiasis (IC).We prospectively studied 63 intensive care unit patients with suspected IC and 40 healthy controls. Blood cultures and MRT-PCR were performed at day 0 and +2, +7, +14 and +21 days in all patients. In addition, beta-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA) were quantified.IC was confirmed in 27 patients. Colonization was significantly higher in patients with IC (96% versus 64%, PaEuroS=aEuroS0.002). The sensitivity, specificity, positive predictive value and negative predictive value of MRT-PCR for the diagnosis of IC were 96.3%, 97.3%, 92.8% and 98.7%, respectively. The positive predictive value and specificity were significantly higher for MRT-PCR than for BDG and CATGA. MRT-PCR performed very well, especially in deep-seated IC (sensitivity 90.9% versus 45.4% for blood culture; PaEuroS=aEuroS0.06). As regards the most appropriate clinical sample for DNA amplification, in this study whole blood and serum presented similar results.MRT-PCR appears to be a useful test for confirming a diagnosis of IC in critically ill patients, especially in those with deep-seated disease. Its high sensitivity and positive predictive value make it a much more efficient tool for the management of IC than other diagnostic procedures and clinical scores.