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. 2023 Jan 5:13:1070688.
doi: 10.3389/fmicb.2022.1070688. eCollection 2022.

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Min Xie  1 , Jin Shao  2   3   4   5   6 , Zhe Wan  2   3   4   5 , Ting Yan  1 , Sainan Zhu  7 , Shuangling Li  1 , Jin Yu  2   3   4   5
Affiliations

Detection of Candida DNA in peritoneal fluids by PCR assay optimizing the diagnosis and treatment for intra-abdominal candidiasis in high-risk ICU patients: A prospective cohort study

Min Xie et al. Front Microbiol. .

Abstract

Background: Intra-abdominal candidiasis (IAC) is the predominant type of invasive candidiasis with high mortality in critically ill patients. This study aimed to investigate whether the polymerase chain reaction (PCR) assay for detecting Candida DNA in peritoneal fluids (PF) is useful in diagnosing and management of IAC in high-risk patients in intensive care unit (ICU).

Methods: A prospective single-center cohort study of surgical patients at high risk for IAC was conducted in the ICU. PF was collected from the abdominal drainage tubes (within 24 h) or by percutaneous puncture. Direct PF smear microscopy, PF culture, blood culture, and serum (1-3)-β-D-glucan were performed in all patients. For Candida PCR assay, the ITS1/ITS4 primers that targeted the ITS1-5.8 s-ITS2 regions were used for PCR, and sequencing analysis was used to identify the pathogen at the species level. IAC was defined according to the 2013 European consensus criteria.

Results: Among 83 patients at high risk for IAC, the IAC criteria were present in 17 (20.5%). The sensitivity and specificity of the Candida PCR assay were 64.7 and 89.4%, respectively, and the area under the receiver operating characteristic curve was 0.77 (95% CI: 0.63-0.91). In this cohort, the positive predictive value and negative predictive value were 90.8% (95% CI: 80.3-96.2%) and 61.1% (95% CI: 36.1-81.7%), respectively. Diagnostic consistency was moderate (kappa 0.529, p < 0.001) according to the 2013 European consensus criteria.

Conclusion: Detection of Candida DNA in PF using PCR can be considered an adjunct to existing routine diagnostic tools which may optimize the diagnosis and antifungal treatment of IAC in high-risk patients in the ICU.

Keywords: Candida spp.; PCR assay; intensive care unit; intra-abdominal candidiasis; peritoneal fluid.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart. IAC, intra abdominal candidiasis.
Figure 2
Figure 2
AUC ROC of positive Candida PCR in PF for IAC diagnosis. AUC ROC: 0.77(95%CI: 0.063–0.91). AUC ROC, area under the receiver operating characteristic curve; PCR polymerase chain reaction; IAC, intra abdominal candidiasis.
See this image and copyright information in PMC

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References

    1. Aguilar G., Delgado C., Corrales I., Izquierdo A., Gracia E., Moreno T., et al. . (2015). Epidemiology of invasive candidiasis in a surgical intensive care unit: an observational study. BMC. Res. Notes 8, 491–496. doi: 10.1186/s13104-015-1458-4, PMID: - DOI - PMC - PubMed
    1. Avni T., Leibovici L., Paul M. (2011). PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. J. Clin. Microbiol. 49, 665–670. doi: 10.1128/JCM.01602-10 - DOI - PMC - PubMed
    1. Bassetti M., Marchetti M., Chakrabarti A., Colizza S., Garnacho-Montero J., Kett D. H., et al. . (2013). A research agenda on the management of intraabdominal candidiasis: results from a consensus of multinational experts. Intensive Care Med. 39, 2092–2106. doi: 10.1007/s00134-013-3109-3 - DOI - PubMed
    1. Bassetti M., Righi E., Ansaldi F., Merelli M., Scarparo C., Antonelli M., et al. . (2015). A multicenter multinational study of abdominal candidiasis: epidemiology, outcomes and predictors of mortality. Intensive Care Med. 41, 1601–1610. doi: 10.1007/s00134-015-3866-24, PMID: - DOI - PubMed
    1. Clancy C. J., Nguyen M. H. (2013). Finding the "missing 50%" of invasive candidiasis: how nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin. Infect. Dis. 56, 1284–1292. doi: 10.1093/cid/cit006, PMID: - DOI - PubMed