POLYMERASE-CHAIN-REACTION USED TO DETECT CANDIDEMIA IN PATIENTS WITH CANDIDURIA

Objectives. Candiduria has been shown to be an early marker of dissemi nated fungal infection in critically ill patients who have undergone s urgery. The management of candidemia and disseminated candidiasis depe nds on rapid and definitive identification of Candida. Routine or fung us-specific blood cultures are unreliable and require a large quantity of blood for incubation. We describe the importance of the polymerase chain reaction (PCR) procedure in the early detection of candidemia i n critically ill patients who develop candiduria and the favorable out come in treating these patients with systemic antifungal therapy. Meth ods. We compared the results of cultures and PCR to detect the presenc e of C. albicans in the blood of two critically ill patients with clin ical candidiasis and candiduria. Results. PCR detected the presence of C. albicans deoxyribonucleic acid (DNA) in urine and blood specimens of both patients in spite of negative blood cultures and did not detec t fungal DNA after systemic antifungal therapy. Conclusions. Candiduri a manifests as an early sign of candidemia, and systemic antifungal th erapy timed appropriately based on the clinical condition and onset of candiduria will improve outcome. Detection of fungal DNA in blood by PCR is of value in establishing the diagnosis. Additional studies with a larger sample size are required to evaluate the specificity and sen sitivity of PCR as a routine diagnostic test for candidemia. (C) 1998, Elsevier Science Inc. All rights reserved.