Abstract
BackgroundBroad-range fungal inter spacer region (ITS) polymerase chain reaction (PCR) has been evaluated for the detection and identification of fungi in clinical specimens from severely immunocompromised patients, but not in non-selected patients. Thus, the aim of this study was to compare the diagnostic performance of ITS PCR with that of fungal culture and to investigate its clinical impact on the diagnosis of fungal infections in non-immunocompromised patients. The corresponding patients’ data were retrieved by detailed medical chart reviews.ResultsResults from 251 specimens showed a high concordance of 89.6 % for ITS PCR and fungal culture. The analytical sensitivity and specificity of ITS PCR considering culture as gold standard were 87.7 and 90.3 %, respectively, the positive and negative predictive value (PPV and NPV) were 76 and 95.5 %, respectively. Assessing the clinical probability of a fungal infection based on detailed chart reviews, PCR had a clinical sensitivity of 88.9 %, a specificity of 86.3 %, a PPV of 64.0 % and a NPV of 96.6 %. The overall performance of fungal broad-range PCR was similar to that of culture.ConclusionsOur data show that, in non-selected and non-immunocompromised patients, the performance of ITS PCR is similar to that of culture for detecting fungal infections, not the least because sensitivity of culture in patients under antifungal treatment is surprisingly high. Compared to culture, PCR has the advantage of a rapid time-to-result (approximately two working days), proper identification of rare pathogens, prompt initiation of a species-targeted antifungal treatment, and prospects for automation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12866-016-0752-1) contains supplementary material, which is available to authorized users.
Highlights
Broad-range fungal inter spacer region (ITS) polymerase chain reaction (PCR) has been evaluated for the detection and identification of fungi in clinical specimens from severely immunocompromised patients, but not in non-selected patients
Clinical specimens and medical record review We performed a retrospective data analysis of clinical specimens from all patients hospitalized on surgical wards for which fungal culture and ITS PCR was requested, including patients surgically treated by ear/nose/throat specialists (ENTs), ophthalmologists and dermatologists at the University Hospital of Zurich (USZ)
Analytical sensitivity and specificity of ITS PCR compared with conventional culture Conventional fungal culture and histopathology are the gold standard for the microbiological diagnosis of fungal infections
Summary
Broad-range fungal inter spacer region (ITS) polymerase chain reaction (PCR) has been evaluated for the detection and identification of fungi in clinical specimens from severely immunocompromised patients, but not in non-selected patients. Clinicians consider and treat invasive fungal infections (IFI) mainly in patients with prolonged and severe neutropenia [6], and in seriously ill patients with extensive candida colonization [7]. In these selected patient groups, decision to treat can be based on criteria established by the European Organisation for Research and Treatment of Cancer (EORTC) or using candida colonization indices (CCI). In less selected patient groups, suspicion of fungal infection mainly develops in patients with signs of infection and an unfavorable clinical course, despite treatment with antibiotics. Compared to patients with suspicion of IFI, an overtreatment is less acceptable in patients with SSI [10, 11]
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