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

1
Division of Infectious Diseases, University of Pittsburgh, Scaife Hall 867, 3550 Terrace St., Pittsburgh, PA 15261, USA
2
Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
*
Author to whom correspondence should be addressed.
J. Fungi 2018, 4(1), 27; https://doi.org/10.3390/jof4010027
Received: 11 January 2018 / Revised: 15 February 2018 / Accepted: 18 February 2018 / Published: 19 February 2018
(This article belongs to the Special Issue Candida and Candidiasis)
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. View Full-Text
Keywords: Candida; candidiasis; candidemia; diagnostic; T2Candida; polymerase chain reaction; 1,3-β-d-glucan; Bayesian Candida; candidiasis; candidemia; diagnostic; T2Candida; polymerase chain reaction; 1,3-β-d-glucan; Bayesian
MDPI and ACS Style

Clancy, C.J.; Nguyen, M.H. Non-Culture Diagnostics for Invasive Candidiasis: Promise and Unintended Consequences. J. Fungi 2018, 4, 27.

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