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Clinical factors associated with a Candida albicans Germ Tube Antibody positive test in Intensive Care Unit patients

Javier Pemán1*, Rafael Zaragoza2, Guillermo Quindós3, Miriam Alkorta4, María S Cuétara5, Juan J Camarena6, Paula Ramírez7, María J Giménez1, Estrella Martín-Mazuelos8, María J Linares-Sicilia9, José Pontón3 and the study group Candida albicans Germ Tube Antibody Detection in Critically Ill Patients (CAGTAUCI)

Author Affiliations

1 Department of Microbiology, Hospital Universitario La Fe, (Av Campanar, 21), Valencia, (46009), Spain

2 Intensive Care Unit, Hospital Universitario Dr. Peset, (Gaspar Aguilar, 90), Valencia, (46017), Spain

3 Departament of Immunology, Microbiology and Parasitology, Facultad de Medicina y Odontología, Universidad del País Vasco, (Apdo 699), Bilbao, (48080), Spain

4 Department of Microbiology, Hospital de Zumarraga, (Argixao Taldea s/n), Zumarraga, (20700), Spain

5 Department of Microbiology Hospital Severo Ochoa, (AV Orellana s/n), Leganés, (28911), Spain

6 Department of Microbiology, Hospital Universitario Dr. Peset, (Gaspar Aguilar, 90), Valencia, (46017), Spain

7 Intensive Care Unit, Hospital Universitario La Fe, (Av Campanar, 21), Valencia, (46009), Spain

8 Department of Microbiology Hospital N.S. de Valme, (Ctra. Cádiz, km 548), Seville, (41014), Spain

9 Department of Microbiology, Facultad de Medicina, (Av Menéndez Pidal s/n), Córdoba, (14004), Spain

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BMC Infectious Diseases 2011, 11:60  doi:10.1186/1471-2334-11-60

Published: 9 March 2011



Poor outcomes of invasive candidiasis (IC) are associated with the difficulty in establishing the microbiological diagnosis at an early stage. New scores and laboratory tests have been developed in order to make an early therapeutic intervention in an attempt to reduce the high mortality associated with invasive fungal infections. Candida albicans IFA IgG has been recently commercialized for germ tube antibody detection (CAGTA). This test provides a rapid and simple diagnosis of IC (84.4% sensitivity and 94.7% specificity). The aim of this study is to identify the patients who could be benefited by the use of CAGTA test in critical care setting.


A prospective, cohort, observational multicentre study was carried out in six medical/surgical Intensive care units (ICU) of tertiary-care Spanish hospitals. Candida albicans Germ Tube Antibody test was performed twice a week if predetermined risk factors were present, and serologically demonstrated candidiasis was considered if the testing serum dilution was ≥ 1:160 in at least one sample and no other microbiological evidence of invasive candidiasis was found.


Fifty-three critically ill non-neutropenic patients (37.7% post surgery) were included. Twenty-two patients (41.5%) had CAGTA-positive results, none of them with positive blood culture for Candida. Neither corrected colonization index nor antifungal treatment had influence on CAGTA results. This finding could corroborate that the CAGTA may be an important biomarker to distinguish between colonization and infection in these patients. The presence of acute renal failure at the beginning of the study was more frequent in CAGTA-negative patients. Previous surgery was statistically more frequent in CAGTA-positive patients.


This study identified previous surgery as the principal clinical factor associated with CAGTA-positive results and emphasises the utility of this promising technique, which was not influenced by high Candida colonization or antifungal treatment. Our results suggest that detection of CAGTA may be important for the diagnosis of invasive candidiasis in surgical patients admitted in ICU.