Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Feb 19;4(1):27.
doi: 10.3390/jof4010027.

Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences

Cornelius J Clancy  1 , M Hong Nguyen  2
Affiliations
Review

Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences

Cornelius J Clancy et al. J Fungi (Basel). .

Abstract

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.

Keywords: 1,3-β-d-glucan; Bayesian; Candida; T2Candida; candidemia; candidiasis; diagnostic; polymerase chain reaction.

PubMed Disclaimer

Conflict of interest statement

Cornelius J. Clancy and M. Hong Nguyen have served as principal investigators for clinical trials sponsored by T2 Biosystems and ViraCor Eurofins. Cornelius J. Clancy has spoken at symposia sponsored by T2 Biosystems.

References

    1. Clancy C.J., Nguyen M.H. Finding the "missing 50%" of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin. Infect. Dis. 2013;56:1284–1292. doi: 10.1093/cid/cit006. - DOI - PubMed
    1. Andes D.R., Safdar N., Baddley J.W., Playford G., Reboli A.C., Rex J.H., Sobel J.D., Pappas P.G., Kullberg B.J. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: A patient-level quantitative review of randomized trials. Clin. Infect. Dis. 2012;54:1110–1122. doi: 10.1093/cid/cis021. - DOI - PubMed
    1. Vergidis P., Clancy C.J., Shields R.K., Park S.Y., Wildfeuer B.N., Simmons R.L., Nguyen M.H. Intra-abdominal candidiasis: The importance of early source control and antifungal treatment. PLoS ONE. 2016;11:e0153247. doi: 10.1371/journal.pone.0153247. - DOI - PMC - PubMed
    1. Clancy C.J., Nguyen M.H. The end of an era in defining the optimal treatment of invasive candidiasis. Clin. Infect. Dis. 2012;54:1123–1125. doi: 10.1093/cid/cis023. - DOI - PubMed
    1. Mikulska M., Calandra T., Sanguinetti M., Poulain D., Viscoli C. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: Recommendations from the third European conference on infections in leukemia. Crit. Care. 2010;14:R222. doi: 10.1186/cc9365. - DOI - PMC - PubMed

LinkOut - more resources