Dimopoulos G, Velegraki A, Pefanis A, Karabinis A
Department of Critical Care, University Hospital Attikon, Greece.
Hepatogastroenterology. 2007 Mar;54(74):354-8.
BACKGROUND/AIMS: Can repeated blood PCR assays in critically ill patients with culture-confirmed candiduria help in the early detection of candidemia?
Urine samples were obtained on the day of admission and if negative were repeated on the 5th ICU day. Upon laboratory confirmation of candiduria, preemptive antifungal therapy was commenced. Whole blood samples were tested simultaneously with conventional cultures and PCR repeated twice weekly for two weeks.
In ICU patients with candiduria, preemptive antifungal therapy resulted in candiduria clearance and clinical improvement in 94% of them. Candida DNAemia (detected in 64 out of 136 repeated PCR assays) persisted for 1 or 2 weeks in a significant number of patients. Even after multiple positive PCR assays from each individual candiduric patient, the specificity and positive predictive value of the assay in the early detection of candidemia were low (negative predictive value was 100%). No differences were detected on demographics among patients with or without candiduria. The correlations (PCR with culture) with kappa test presented a poor agreement (K = 0.103, Kmin= -0679, Kmax = 0.103).
PCR in the blood should not be used in early diagnosis of (but it could help in excluding) candidemia, in ICU patients with candiduria.
背景/目的：对于尿培养确诊为念珠菌尿的重症患者，重复进行血液PCR检测能否有助于早期发现念珠菌血症？
在入院当天采集尿样，若结果为阴性，则在入住重症监护病房第5天重复采集。实验室确诊念珠菌尿后，开始进行抢先抗真菌治疗。全血样本与传统培养同时进行检测，PCR每周重复两次，共持续两周。
在患有念珠菌尿的重症监护病房患者中，抢先抗真菌治疗使94%的患者念珠菌尿清除且临床症状改善。相当一部分患者的念珠菌血症（在136次重复PCR检测中有64次检测到）持续1或2周。即使在每位念珠菌尿患者多次PCR检测呈阳性后，该检测在早期检测念珠菌血症中的特异性和阳性预测值仍较低（阴性预测值为100%）。念珠菌尿患者与非念珠菌尿患者在人口统计学特征上未检测到差异。PCR与培养结果的kappa检验相关性较差（K = 0.103，Kmin = -0.679，Kmax = 0.103）。
对于患有念珠菌尿的重症监护病房患者，血液PCR检测不应用于念珠菌血症的早期诊断（但有助于排除）。
