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Mycology

PCR Diagnosis of Invasive Candidiasis: Systematic Review and Meta-Analysis

Tomer Avni, Leonard Leibovici, Mical Paul
Tomer Avni
1Medicine, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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  • For correspondence: tomerav@clalit.org.il
Leonard Leibovici
1Medicine, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Mical Paul
2Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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DOI: 10.1128/JCM.01602-10
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    Fig. 1.

    HROC curves. (A) TP level I individuals (with candidemia) versus TN at-risk patients (49 studies). (B) TP level II individuals (with proven/probable IC) versus TN at-risk patients (17 studies). (C) TP level III individuals (with proven/probable/possible IC) versus TN at-risk patients (20 studies). In each panel, the shaded square marks the summary point. Open circles, study estimates; solid lines, HSROC curves; dashed lines, 95% confidence regions; dotted lines, 95% prediction regions.

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  • Table 1.

    Results of the diagnostic meta-analyses (hierarchical summary receiver operating characteristic curves)a

    Comparison with TN at-risk patients (no. of studies)IllustrationSensitivitySpecificityDORLikelihood ratio
    PositiveNegative
    TP I individuals (with candidemia)
        Allb (49)Fig. 1A; Fig. S3 in the supplemental material0.95 (0.88–0.98)0.92 (0.88–0.95)229.1 (85–617.3)12.3 (7.9–19.3)0.05 (0.02–0.14)
        Yr, ≥2000b,c (27)Fig. S4A in the supplemental material0.93 (0.91–0.97)0.94 (0.89–0.97)195.7 (70.9–540.4)15.4 (9–26.4)0.08 (0.03–0.21)
        Subgroup analysis: whole blood; rRNA or p450 gene target; detection limit, ≤10 CFU/ml; SeptiFast excluded (23)Fig. S5 in the supplemental material0.98 (0.85–1)0.90 (0.82–0.85)394.9 (56.4–2,765.4)10.2 (5.5–18.9)0.03 (0.004–0.18)
    TP II individuals (with proven/probable IC)
        Allb (17)Fig. 1B0.93 (0.82–0.98)0.95 (0.87–0.98)251.9 (57.4–1,106)18.2 (7–47.2)0.07 (0.03–0.2)
        Yr, ≥2000 (8)Fig. S4B in the supplemental material0.87 (0.70–0.95)0.96 (0.92–0.98)178.9 (51.1–626.8)24.3 (11.3–52.4)0.14 (0.05–0.33)
    TP III individuals (with proven/probable/possible IC)
        All (20)Fig. 1C0.73 (0.58–0.83)0.91 (0.82–0.96)26.9 (10.5–69.2)8.1 (4–16.5)0.3 (0.9–0.48)
        Yr, ≥2000 (11)Fig. S4C in the supplemental material0.71 (0.52–0.85)0.95 (0.92–0.97)47.3 (16.9–132.9)14.4 (8–25.2)0.3 (0.17–0.55)
    • ↵a Values in parentheses are 95% confidence intervals.

    • ↵b Model fit using Stata's gllamm (generalized linear latent and mixed models) option.

    • ↵c Study end year. If the year when the study ended was not reported in the article, we used the publication year minus 2.

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    Files in this Data Supplement:

    • Supplemental file 1 - Tables S1 (QUADAS items assessed, adapted for the current review), S2 (Study characteristics), and S3 and S4 (Study design and methods according to QUADAS) and Fig. S1 (Study flow), S2 (QUADAS methodological assessment results), S3 (Sensitivity and specificity for TP level I patients versus TN at-risk patients), S4 (HSROC curves for the subgroup of studies published in or after 2000), S5 (TP level I patients versus TN at-risk patients: subgroup of studies using whole blood samples, rRNA, or p450 target genes, an in vitro detection limit of <10 CFU /ml, and PCR other than Septifast), and S6 (Metaregression of colonization rates on specificity in the comparison of TP level III patients versus TN at-risk patients)
      Zipped MS Word document, 298K.
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PCR Diagnosis of Invasive Candidiasis: Systematic Review and Meta-Analysis
Tomer Avni, Leonard Leibovici, Mical Paul
Journal of Clinical Microbiology Feb 2011, 49 (2) 665-670; DOI: 10.1128/JCM.01602-10

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PCR Diagnosis of Invasive Candidiasis: Systematic Review and Meta-Analysis
Tomer Avni, Leonard Leibovici, Mical Paul
Journal of Clinical Microbiology Feb 2011, 49 (2) 665-670; DOI: 10.1128/JCM.01602-10
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