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Candida albicans Germ-Tube Antibody: Evaluation of a New Automatic Assay for Diagnosing Invasive Candidiasis in ICU Patients

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Testing for Candida albicans germ-tube antibody IFA IgG assay (CAGTA) is used to detect invasive candidiasis infection. However, most suitable assays lack automation and rapid single-sample testing. The CAGTA assay was adapted in an automatic monotest system (invasive candidiasis [CAGTA] VirClia® IgG monotest (VirClia®), a chemiluminescence assay with ready-to-use reagents that provides a rapid objective result. CAGTA assay was compared with the monotest automatic VirClia® assay in order to establish the diagnostic reliability, accuracy, and usefulness of this method. A prospective study with 361 samples from 179 non-neutropenic critically ill adults patients was conducted, including 21 patients with candidemia, 18 with intra-abdominal candidiasis, 84 with Candida spp. colonization, and 56 with culture-negative samples, as well as samples from ten healthy subjects. Overall agreement between the two assays (CAGTA and VirCLIA) was 85.3%. These assays were compared with the gold-standard method to determine the sensitivity, specificity as well as positive and negative predictive values. In patients with candidemia, values for CAGTA and VirCLIA assays were 76.2 versus 85.7%, 80.3 versus 75.8%, 55.2 versus 52.9%, and 91.4 versus 94.3%, respectively. The corresponding values in patients with intra-abdominal candidiasis were 61.1 versus 66.7%, 80.3 versus 75.8%, 45.8 versus 42.9%, and 88.3 versus 89.3%, respectively. No differences were found according to the species of Candida isolated in culture, except for Candida albicans and C. parapsilosis, for which VirClia® was better than CAGTA. According to these results, the automated VirClia® assay was a reliable, rapid, and very easy to perform technique as tool for the diagnosis invasive candidiasis.

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VirClia® reagents were supplied by Vircell SL, Granada, Spain. Vircell SL had no role in the collection, analysis, interpretation of data, or in the decision to submit the study for publication. We thank Marta Pulido, MD, for editing the manuscript. The Cava Trem Study Group: J.I. Tomás, M. Gurpegui, V. González, and A. Rezusta (Hospital Universitario Miguel Servet, Zaragoza); C. León, E. Martin-Mazuelos, C. Castro, A. Loza, A. Úbeda, M. Parra-Sánchez, I. Zakariya-Yousef, and D. Macías (Hospital Universitario de Valme, Sevilla); A. Úbeda (Hospital Punta de Europa, Algeciras, Cádiz); A. Rodríguez, M. Bodi, F. Gómez, S. Trefler, M. Llauradó, and R. Güell (Hospital Universitari Joan XXIII, Tarragona); R. González, FJ. Díaz, Raúl González, J.M. Marcos, D. Carriedo, I. Fernández, E. Valverde, A. Esteban, and T. Marrodan (Complejo Asistencial de León, León); A. Arenzana, C. González, A. I. Suárez (Hospital Universitario Virgen Macarena, Sevilla); J. Ballús, F. Esteve, and J. Ayats (Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona); G. Aguilar, R. Badenes, C. Ferrando, D. Navarro, J.A. Carbonell, C. García, A. Gómez, L. Henao, A. Miñana, J. Puig, and F.J. Belda (Hospital Clínico Universitario, Valencia); A. Puppo, J. Garnacho, J.A. Márquez, A. Gutiérrez, and M. Ruiz (Hospital Universitario Virgen del Rocío, Sevilla); V. Jeréz, V. Trasmonte, P. Martínez, D. Pérez, M. Fajardo, C. Gaona, and C. Muñoz, (Hospital Infanta Cristina, Badajoz); G. Tamayo, A. Martínez, F. Labayen, J.R. Iruretagoyena, L. López, and J.L. Hernández (Hospital Universitario Cruces, Barakaldo, Bizkaia); S. Ruiz-Santana, M.A. Hernández, A. Bordes, and N. Ojeda (Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria); and J.D. Jiménez (Hospital de Don Benito-Villanueva, Don Benito, Badajoz), Spain.

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Correspondence to Manuel Parra-Sánchez.

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None of the authors has any conflict of interest to be disclosed.

Ethical Approval

The study was conducted with the approval of the Ethics Committee of Hospital Universitario de Valme, Seville, Spain (CEIC-A1, ref. 350/12).

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Parra-Sánchez, M., Zakariya-Yousef Breval, I., Castro Méndez, C. et al. Candida albicans Germ-Tube Antibody: Evaluation of a New Automatic Assay for Diagnosing Invasive Candidiasis in ICU Patients. Mycopathologia 182, 645–652 (2017).

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