抄録
The implementation of the diagnosis of candidemia is important for the prompt initiation of antifungal therapy. Two hundred and twenty-five patients with high risk for candidemia were prospectively followed-up, in a two year period. Blood cultures by automated BactAlert system and PCR from whole blood to detect candidemia were done in all patients, with more than 15 days of hospitalization in high risk areas. DNA was extracted and amplified using ITS5 and ITS4 base pair primers and the PCR products were sequenced for identification of Candida spp. Positive blood culture for Candida was considered the gold standard for candidemia diagnosis. Variables associated with the development of candidemia diagnosed by positive blood culture were also evaluated in the patients. The overall mortality of the patients was 26.1% and the mortality rate in candidemic and non-candidemic patients was 41.9% and 22.5%, respectively (p=0.009). PCR sensitivity and specificity were 72.1% and 91.2%, respectively. Positive and negative predictive values were: 65.9% and 93.2%, respectively. The logistic regression of the multivariate analysis showed that parenteral nutrition (p<.0001); fever (p=0.01); neutropenia (p=0.04) and urinary underlying catheter (p=0.02) were significant variables associated with the development of candidemia. The PCR technique followed by DNA sequencing was similar in the diagnosis of candidemia. In high risk patients with positive PCR for Candida spp., in blood sample, strongly suggested the diagnosis of candidemia.
