Detection of fungal DNA in peritoneal fluids by a PCR DNA low-density microarray system and quantitation of serum (1-3)- -D-glucan in the diagnosis of peritoneal candidiasis

Abstract

Microbiological documentation of peritoneal candidiasis (PC) is hampered by the low numbers of yeasts observable by direct microscopic examination and recoverable by culture methods. The performance of a polymerase chain reaction (PCR) DNA Low-Density Microarray System (CLART STIs B) was compared to that of BACTEC FX automated culture method for the detection of Candida spp. in 161 peritoneal fluids (PF) from patients with peritonitis. The clinical utility of (1-3)-β-d-glucan (BDG) antigenemia in the diagnosis of PC was evaluated in 42 of these patients. The overall agreement between the PCR assay and the culture method was good (κ = 0.790), and their sensitivities were 93.5% and 74.19%, respectively. Serum BDG levels in patients with Candida spp. in PFs (median, 200.3 pg/mL; Range, 22.0-523.4 pg/mL) was significantly higher (P = 0.002) than those found in patients without the yeast (median, 25.3 pg/mL; Range, 0-523.4 pg/mL). Our study demonstrates the potential clinical utility of molecular methods and the measurement of serum BDG levels for the diagnosis of PC.

Is ß-d-glucan Relevant for the Diagnosis and Follow-Up of Intensive Care Patients with Yeast-Complicated Intra-Abdominal Infection?

“…However, all peritoneal samples were sent to a mycological lab and were seeded on specific media to avoid false negative results. Furthermore, the sensitivity of peritoneal culture to yeast is clearly higher than that of blood culture [ 36 ]. A recent study did compare PCR approach to culture-based methods on the peritoneal fluid to detect yeasts’ pathogens.…”

“…A recent study did compare PCR approach to culture-based methods on the peritoneal fluid to detect yeasts’ pathogens. The overall agreement between the PCR assay and the culture method was good ( κ = 0.79), and their sensitivities for the diagnosis of intraperitoneal candidiasis were 93.5% and 74.1%, respectively [ 36 ]. The measurement of BDG could be another concern.…”

Cost Effectiveness of Candida Polymerase Chain Reaction Detection and Empirical Antifungal Treatment among Patients with Suspected Fungal Peritonitis in the Intensive Care Unit

“…This situation is similar to a stratified medicine approach; thus, we decided to integrate test performances into the model [36]. PCR specificity and sensitivity were derived from a meta-analysis related to PCR detection of Candida in the blood [28] and culture specificity and sensitivity from an exploratory study related to detection of Candida in cultured peritoneal fluid [29]. A difference in limits of detection was observed between the use of PCR to detect C. krusei and C. glabrata and the use of PCR to detect all Candida species [26].…”

“…In this context, any diagnostic test that allows rapid and sensitive detection of Candida species is likely to have important clinical and economic impacts. New in vitro diagnostic assays, based on polymerase chain reaction (PCR), are now available and should allow faster adjustment of antifungal treatments [26][27][28][29].…”

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

“…However, in a population with a low proportion of candidemia, especially for IAC without candidemia, the performance of Candida PCR using blood samples is still controversial [13,14] . Corrales et al [15] explored the utility of Candida PCR in PF of patients with peritonitis. This study compared the accuracy of a PCR DNA low-density microarray system (CLART STIs B) with the BACTEC FX automated culture method for detecting Candida spp.…”