RESUMO
Multiplex quantitative real-time PCR (MRT-PCR) using blood can improve the diagnosis of intra-abdominal candidiasis (IAC). We prospectively studied 39 patients with suspected IAC in the absence of previous antifungal therapy. Blood cultures, MRT-PCR, and ß-D-glucan (BDG) in serum were performed in all patients. IAC was defined according to the 2013 European Consensus criteria. For MRT-PCR, the probes targeted the ITS1 or ITS2 regions of ribosomal DNA. Candidaemia was confirmed only in four patients (10%), and IAC criteria were present in 17 patients (43.6%). The sensitivity of MRT-PCR was 25% but increased to 63.6% (P = .06) in plasma obtained prior to volume overload and transfusion; specificity was above 85% in all cases. BDG performance was improved using a cutoff > 260 pg/ml, and improvement was not observed in samples obtained before transfusion. In this cohort of high risk of IAC and low rate of bloodstream infection, the performance of non-culture-based methods (MRT-PCR or BDG) was moderate but may be a complementary tool given the limitations of diagnostic methods available in clinical practice. Volume overload requirements, in combination with other factors, decrease the accuracy of MRT-PCR in patients with IAC.
Assuntos
Candidíase Invasiva/sangue , Candidíase Invasiva/diagnóstico , Infecções Intra-Abdominais/microbiologia , Reação em Cadeia da Polimerase Multiplex , beta-Glucanas/sangue , Antifúngicos/farmacologia , Sondas de DNA , Feminino , Humanos , Infecções Intra-Abdominais/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Anestesia Epidural/métodos , Anestesia Obstétrica/métodos , Paralisia Cerebral , Complicações na Gravidez , Adulto , Analgesia Epidural/métodos , Analgesia Obstétrica/métodos , Toxinas Botulínicas Tipo A/uso terapêutico , Paralisia Cerebral/complicações , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Recém-Nascido , Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares , Masculino , Espasticidade Muscular/tratamento farmacológico , Gravidez , Escoliose/etiologiaRESUMO
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