Background.The sensitivity of blood cultures for diagnosing invasive candidiasis (IC) is poor.Methods.We performed a validated Candida real-time polymerase chain reaction (PCR) and the Fungitell 1,3-b-D-glucan (BDG) assay on blood samples collected from prospectively identified patients with IC (n 5 55) and hospitalized controls (n 5 73).Patients with IC had candidemia (n 5 17), deep-seated candidiasis (n 5 33), or both (n 5 5).Controls had mucosal candidiasis (n 5 5), Candida colonization (n 5 48), or no known Candida colonization (n 5 20).Results.PCR using plasma or sera was more sensitive than whole blood for diagnosing IC (P 5 .008).Plasma or sera PCR was more sensitive than BDG in diagnosing IC (80% vs 56%; P 5 .03),with comparable specificity (70% vs 73%; P 5 .31).The tests were similar in diagnosing candidemia (59% vs 68%; P 5 .77),but PCR was more sensitive for deep-seated candidiasis (89% vs 53%; P 5 .004).PCR and BDG were more sensitive than blood cultures among patients with deep-seated candidiasis (88% and 62% vs 17%; P 5 .0005and .003,respectively).PCR and culture identified the same Candida species in 82% of patients.The sensitivity of blood cultures combined with PCR or BDG among patients with IC was 98% and 79%, respectively.Conclusions.Candida PCR and, to a lesser extent, BDG testing significantly enhanced the ability of blood cultures to diagnose IC.

Performance of Candida Real-time Polymerase Chain Reaction, -D-Glucan Assay, and Blood Cultures in the Diagnosis of Invasive Candidiasis