Value of ß-D-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions.

PURPOSE: To assess the value of (1→3)-ß-D: -glucan (BDG), Candida albicans germ tube antibody (CAGTA), C-reactive protein (CRP), and procalcitonin (PCT) levels for the diagnosis of invasive candidiasis (IC) and for differentiating Candida spp. colonization from infection in ICU patients with severe abdominal conditions (SAC). METHODS: Prospective study of 176 non-neutropenic patients, with SAC at ICU admission, and expected to stay at least 7 days. Surveillance cultures and BDG, CAGTA, CRP, and PCT levels were performed on the third day of ICU stay and twice a week for four consecutive weeks. Patients were grouped into invasive candidiasis (IC), Candida colonization, and neither colonized/nor infected. The classification and regression tree (CART) analysis was used to predict IC in colonized patients. The discriminatory ability of the obtained prediction rule was assessed by the area under the ROC curve (AUC). RESULTS: The probabilities of IC were 59.3 % for the terminal node of BDG greater than 259 pg/mL and 30.8 % for BDG less than 259 pg/mL and CAGTA positivity, whereas there was a 93.9 % probability in predicting the absence of IC for BDG less than 259 pg/mL and negative CAGTA. Using a cutoff of 30 % for IC probability, the prediction rule showed 90.3 % sensitivity, 54.8 % specificity, 42.4 % positive predictive value, and 93.9 % negative predictive value with an AUC of 0.78 (95 % confidence interval 0.76-0.81). Significant differences in CRP (p = 0.411) and PCT (p = 0.179) among the studied groups were not found. CONCLUSIONS: BDG with a positive test for CAGTA accurately differentiated Candida colonization from IC in patients with SAC, whereas CRP and PCT did not.

Update on catheter-related bloodstream infections in ICU patients.

The present article is an update of the literature on catheter-related bloodstream infections in ICU patients. A multidisciplinary group of Spanish physicians with an interest in bloodstream infections selected the most important recently published papers produced in the field. One of the members of the group discussed the content of each of the selected papers, with a critical review by other members of the panel. After a review of the state of the art, papers from the fields of epidemiology, causative microorganisms (bacterial and fungal), risk factors and prognosis, pathogenesis, laboratory diagnosis and prevention were discussed by the group.

Update on catheter-related bloodstream infections in ICU patients

ResumenEl artículo presente recoge una actualización bibliográfica de la bacteriemia relacionada con catéteres en unidades de cuidados intensivos. Un grupo multidisciplinario de clínicos españoles con experiencia en las infecciones relacionadas con catéteres seleccionó las publicaciones más importantes en este campo aparecidas recientemente. El contenido de cada uno de los artículos seleccionados fue expuesto y discutido por uno de los miembros del grupo, después de lo cual los miembros restantes efectuaron una revisión crítica.Tras la revisión de la situación actual, el grupo discutió las publicaciones procedentes de los campos de la epidemiología, la etiología, la detección de factores de riesgo, la evolución y el pronóstico, la patogénesis, el diagnóstico de laboratorio y la prevención (AU)

The present article is an update of the literature on catheter-related bloodstream infections in ICU patients.A multidisciplinary group of Spanish physicians with an interest in bloodstream infections selected themost important recently published papers produced in the field. One of the members of the group discussedthe content of each of the selected papers, with a critical review by other members of the panel.After a review of the state of the art, papers from the fields of epidemiology, causative microorganisms(bacterial and fungal), risk factors and prognosis, pathogenesis, laboratory diagnosis and prevention werediscussed by the group (AU)