ABSTRACT
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.
Subject(s)
Candidiasis, Invasive/blood , Candidiasis, Invasive/diagnosis , Intraabdominal Infections/microbiology , Multiplex Polymerase Chain Reaction , beta-Glucans/blood , Antifungal Agents/pharmacology , DNA Probes , Female , Humans , Intraabdominal Infections/blood , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Sensitivity and SpecificitySubject(s)
Anesthesia, Epidural/methods , Anesthesia, Obstetrical/methods , Cerebral Palsy , Pregnancy Complications , Adult , Analgesia, Epidural/methods , Analgesia, Obstetrical/methods , Botulinum Toxins, Type A/therapeutic use , Cerebral Palsy/complications , Elective Surgical Procedures , Female , Humans , Infant, Newborn , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Male , Muscle Spasticity/drug therapy , Pregnancy , Scoliosis/etiologyABSTRACT
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