METHODS: This single-centre retrospective observational study evaluated 2479 intensive care unit (ICU) cases from January 2016 to December 2018. A total of 76 identified candidemia cases and 76 matched control cases were analyzed. The patients' demographic characteristics and illness severity were analyzed, and possible risk factors for candidemia were investigated.
RESULTS: Multivariate logistic regression analysis identified renal replacement therapy (RRT) (odds ratio [OR]: 52.83; 95% confidence interval [CI]: 7.82-356.92; P < 0.0001), multifocal Candida colonization (OR: 23.55; 95% CI: 4.23-131.05; P < 0.0001), parenteral nutrition (PN) (OR: 63.67; 95% CI: 4.56-889.77; P = 0.002), and acute kidney injury (AKI) (OR: 7.67; 95% CI: 1.24-47.30; P = 0.028) as independent risk factors. A new prediction score with a cut-off value of 5.0 (80.3% sensitivity and 77.3% specificity) was formulated from the logit model equation.
CONCLUSIONS: Renal replacement therapy, AKI, PN, and multifocal Candida colonization were the independent risk factors for the new candidemia prediction score with high discriminatory performance and predictive accuracy.
METHODS: Three separate multiplexed PCR reactions were designed together with a testing algorithm, using biotin, digoxigenin and Tamra fluorophore-labelled fungal internal transcribed spacer universal fungal primers, fungal genera-specific primers, and species-specific primers to produce labelled PCR products that were detected on the LFA dipstick. The LFA dipstick, in a modified sandwich format, utilises immobilised antibodies complementary to the fluorophore labels on the PCR products, and gold nanoparticles to form a visible red line that indicates the presence of the targeted fungus. To validate the developed system, 203 clinical samples suspected of fungal infection were collected from two hospitals in Kuala Lumpur and tested.
RESULTS: The limits of detection of the multiplexed PCR were in the range of 5-100 CFU/mL for fungal spiked human blood samples. Against the clinical diagnosis of proven or probable IFDs, the findings show that the LFA system produced a high specificity of 99.4 % while the sensitivity was only moderate at 47.8 % due to the difficulty of extracting fungal DNA from blood samples. The positive and negative predictive values however were promising at 91.7 % and 93.7 %, respectively.
CONCLUSION: The developed LFA system has great potential for further refinement to be used as a new tool in the detection of IFDs.