Recent advances in molecular and non-PCR-based platforms for the rapid diagnosis of invasive candidasis in the ICU

Abstract

Invasive candidasis (IC) accounts for 15–30% of all nosocomial intensive care unit (ICU) infections. Two-thirds of infections are due to candidemia, a rate 5–10 times higher compared with that in the general hospital population. Crude mortality rates and associated health costs remain high, despite advances in antifungal therapy. Candida albicans remains the most frequently isolated species (45%) although there has been a slow but definite shift towards non-C. albicans species (especially Candida glabrata) infections, which has been attributed to the increased use of fluconazole prophylaxis in some centres. Early antifungal therapy significantly reduces IC-related mortality but is often delayed because ‘gold standard’ diagnosis by culture and/or histology is insensitive (for example, 50% candidemia cases not detected by blood culture) and slow (at least 48–96 hours required for species detection and identification). This article highlights a number of recent advances in molecular and non-PCR-based technologies that have enabled more rapid diagnosis of IC in the ICU (a recent review provides a comprehensive summary of molecular and serological methods in diagnostic mycology).