期刊
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
卷 73, 期 -, 页码 13-19出版社
OXFORD UNIV PRESS
DOI: 10.1093/jac/dky048
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资金
- PROgrama MULtidisciplinar para la Gestion de Antifungicos y la Reduccion de Candidiasis Invasora (PROMULGA) II Project
- Instituto de Salud Carlos III Madrid Spain
- European Regional Development Fund (FEDER) [PI13/01148, CM15/00181]
- T2 Biosystems
Objectives: Diagnosis of complicated candidaemia represents a challenge for clinicians since early clinical manifestations may be non-specific and difficult to identify, thus precluding an appropriate treatment. Patients and methods: This was a multicentre prospective study for predicting complicated episodes in patients with bloodstream infection caused by Candida species, while assessing the value of follow-up blood cultures (BCs) and the persistence of positive results for T2Candida MR (T2MR) and blood beta-D-glucan (BDG) tests. Immediately after the first positive BC yielding Candida species, samples were obtained on days 0, ! 2, ! 4, ! 7 and ! 14, to simultaneously perform follow-up BC, T2MR and BDG. An episode of candidaemia was defined as 'complicated' when (i) it caused septic metastasis; and/or (ii) it was the cause of the patient's death. Results: From January to June 2017, 30 patients were enrolled in the study. Of these, nine (30%) had complicated candidaemia. Values of persistently positive samples for the prediction of complicated episodes for BCs, T2MR and BDG, respectively, were as follows: sensitivity (44.4%, 100%, 100%); specificity (76.1%, 76.1%, 38.9%); positive predictive value (PPV) (44.4%, 64.2%, 40.9%) and negative predictive value (NPV) (76.1%, 100%, 100%). In multivariate analysis, having a positive T2MR within the first 5 days was associated with an almost 37-fold higher risk of developing complicated candidaemia. Conclusions: The T2MR test performed in patients with proven candidaemia may be a better marker of complicated infection than follow-up BCs or BDG. It is possible that this test may change current clinical practice, influencing the length and type of antifungal therapy in this population.
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