Clinical factors associated with a Candida albicansGerm Tube Antibody positive test in Intensive Care Unit patients

Abstract

BackgroundPoor outcomes of invasive candidiasis (IC) are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA). This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity). The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting.MethodsA prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU) of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was ≥ 1:160 in at least one sample and no other microbiological evidence of invasive candidiasis was found.ResultsFifty-three critically ill non-neutropenic patients (37.7% post surgery) were included. Twenty-two patients (41.5%) had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients.ConclusionsThis study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not influenced by high Candida colonization or antifungal treatment. Our results suggest that detection of CAGTA may be important for the diagnosis of invasive candidiasis in surgical patients admitted in ICU.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…There are only two previous reports of the same group [9,10] assessing the predictive value of CAGTA for IC in a cohort of 53 critically ill non-neutropenic patients in which CAGTA was measured twice a week. Twenty-two patients (41.5 %) had CAGTA-positive results and none of them had a positive blood culture for Candida.…”

“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

“…Also, a test based on the detection of antibodies against the surface of C. albicans germ tubes (CAGTA) has been commercialized [8]. Two newly published studies showed a significant decrease in mortality in ICU patients with a CAGTA-positive result especially in those with increasing CAGTA values who had been treated with antifungals [9,10]. C-reactive protein (CRP) [11] and procalcitonin (PCT) [12,13] have been also reported to be valuable markers.…”

Molecular and Nonmolecular Diagnostic Methods for Invasive Fungal Infections

“…A study published in 2009 by Zaragoza et al showed that intensive care unit (ICU) patients with a CAGTA-positive assay had lower mortality than patients with a negative assay, likely due to the administration of the appropriate empirical treatment in this group of patients (33). A more recent study, published in 2011 by the same group, suggests that the CAGTA assay is not affected by Candida colonization or intake of antifungal agents, which makes it particularly useful in the ICU setting (34). In an effort to establish the position of this test in routine clinical practice, Leon et al introduced a new diagnostic tool for invasive candidiasis in 2011, based on positive CAGTA and ␤-glucan assays (35).…”

The Role of Biomarkers for Starting Antifungals in the Intensive Care Unit

“…45 Preliminary results suggest that it may help in the diagnosis of invasive candidiasis early in critically ill patients at a high risk of developing the condition. 46 In a prospective study, Leon et …”