Skip to main content
Log in

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

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Intensive Care. 2011;. doi:10.1186/2110-5820-1-37.

    Google Scholar 

  2. Lortholary O, Renaudat C, Sitbon K, et al. Worrisome trends in incidence and mortality of candidemia in intensive care units (Paris area, 2002–2010). Intensive Care Med. 2014;40(9):1303–12.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Colombo AL, Guimaraes T, Sukienik T, et al. Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: an analysis of five multicenter studies sequentially conducted over a 9-year period. Intensive Care Med. 2014;40(10):1489–98.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309–17.

    Article  PubMed  Google Scholar 

  5. Pappas PG, Kauffman CA, Andes DR, et al. Executive summary: clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;62(4):409–17.

    Article  PubMed  Google Scholar 

  6. Fernandez J, Erstad BL, Petty W, Nix DE. Time to positive culture and identification for Candida blood stream infections. Diagn Microbiol Infect Dis. 2009;64(4):402–7.

    Article  PubMed  Google Scholar 

  7. Clancy CJ, Nguyen MH. Finding the ‘‘missing 50%’’ of invasive candidiasis: how non-culture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis. 2013;56(9):1284–92.

    Article  PubMed  Google Scholar 

  8. Maubon D, Garnaud C, Calandra T, Sanglard D, Cornet M. Resistance of Candida spp. to antifungal drugs in the ICU: where are we now? Intensive Care Med. 2014;40(9):1241–55.

    Article  CAS  PubMed  Google Scholar 

  9. Zaragoza R, Peman J, Quindos G, et al. Clinical significance of the detection of Candida albicans germ tube-specific antibodies in critically ill patients. Clin Microbiol Infect. 2009;15(6):592–5.

    Article  CAS  PubMed  Google Scholar 

  10. Peman J, Zaragoza R, Quindos R, et al. Clinical factors associated with a Candida albicans germ tube antibody positive test in intensive care unit patients. BMC Infect Dis. 2011;11:60.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Martinez-Jimenez MC, Muñoz P, Guinea J, et al. Potential role of Candida albicans germ tube antibody (CAGTA) in the diagnosis of deep-seated candidemia. Med Mycol. 2014;52(3):270–5.

    Article  CAS  PubMed  Google Scholar 

  12. Martínez-Jiménez MC, Muñoz P, Valerio M, et al. Candida biomarkers in patients with candidaemia and bacteraemia. J Antimicrob Chemother. 2015;70(8):2354–61.

    Article  PubMed  Google Scholar 

  13. Martín-Mazuelos E, Loza A, Castro C, et al. β-D-Glucan and Candida albicans germ tube antibody in ICU patients with invasive candidiasis. Intensive Care Med. 2015;41(8):1424–32.

    Article  PubMed  Google Scholar 

  14. León C, Ruiz-Santana S, Saavedra P, et al. Contribution of Candida biomarkers and DNA detection for the diagnosis of invasive candidiasis in ICU patients with severe abdominal conditions. Crit Care. 2016;20(1):149. doi:10.1186/s13054-016-1324-3.

    Article  PubMed  PubMed Central  Google Scholar 

  15. León C, Ruiz-Santana S, Saavedra P, et al. Usefulness of the Candida score for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med. 2009;37(5):1624–33.

    Article  PubMed  Google Scholar 

  16. Alexander BD, Pfaller MA. Contemporary tools for the diagnosis and management of invasive mycoses. Clin Infect Dis. 2006;43(Suppl 1):15–27.

    Article  Google Scholar 

  17. Lam SW, Eschenauer GA, Carver PL. Evolving role of early antifungals in the adult intensive care unit. Crit Care Med. 2009;37(5):1580–93.

    Article  CAS  PubMed  Google Scholar 

  18. Shorr AF, Gupta V, Sun X, Johannes RS, Spalding J, Tabak YP. Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database. Crit Care Med. 2009;37(9):2519–26.

    Article  PubMed  Google Scholar 

  19. Azoulay E, Dupont H, Tabah A, et al. Systemic antifungal therapy in critically ill patients without invasive fungal infection. Crit Care Med. 2012;40(3):813–22.

    Article  CAS  PubMed  Google Scholar 

  20. Leon C, Ruiz-Santana S, Saavedra P, et al. Value of b-D-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions. Intensive Care Med. 2012;38(8):1315–25.

    Article  CAS  PubMed  Google Scholar 

  21. Moragues MD, Ortiz N, Iruretagoyena JR, et al. Evaluation of a new commercial test (Candida albicans IFA IgG) for the serodiagnosis of invasive candidiasis. Enferm Infecc Microbiol Clin. 2004;22(2):83–8.

    Article  PubMed  Google Scholar 

  22. Linares MJ, Javier MR, Villanueva JL, et al. Detection of antibodies to Candida albicans germ tubes in heroin addicts with systemic candidiasis. Clin Microbiol Infect. 2001;7(4):218–26.

    Article  CAS  PubMed  Google Scholar 

  23. García-Ruiz JC, del Carmen Arilla M, Regúlez P, Quindós G, Alvarez A, Pontón J. Detection of antibodies to Candida albicans germ tubes for diagnosis and therapeutic monitoring of invasive candidiasis in patients with hematologic malignancies. J Clin Microbiol. 1997;35(12):3284–7.

    PubMed  PubMed Central  Google Scholar 

  24. Puig-Asensio M, Padilla B, Garnacho-Montero J, Zaragoza O, Aguado JM, Zaragoza R, et al. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20(4):O245–54.

    Article  CAS  PubMed  Google Scholar 

  25. Caggiano G, Coretti C, Bartolomeo N, Lovero G, De Giglio O, Montagna MT. Candida bloodstream infections in Italy: changing epidemiology during 16 years of surveillance. Biomed Res Int. 2015;. doi:10.1155/2015/256580.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Manuel Parra-Sánchez.

Ethics declarations

Conflict of interest

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).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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). https://doi.org/10.1007/s11046-017-0125-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-017-0125-9

Keywords

Navigation