Candidal antigenemia: a prognostic determinant.

We evaluated 98 hospital patients, debilitated by serious illness or major surgery with or without candiduria, for the development of candidal antigenemia with a commercially prepared antibody-coated latex particle assay. Group 1 (41 patients) had persistent Candida albicans candiduria (colony counts of more than 10,000 per ml.), group 2 (25 patients) had candiduria (more than 10,000 colonies per ml.) due to species other than Candida albicans and group 3 (32 patients) had no documented candiduria. Indwelling urinary catheters were present in 78 per cent of the patients in group 1, 80 per cent in group 2 and 66 per cent in group 3. In group 1 elevated candidal antigen titers of 1 to 8 or more occurred in 87 per cent of the patients with candiduria and other positive sites and in 31 per cent of those with candiduria alone (p less than 0.005), compared to 50 and 18 per cent, respectively, in group 2. In group 3 positive candidal cultures subsequently developed from other sites in 6 patients, 2 of whom had elevated titers. Patients with indwelling urinary catheters and candiduria had higher candidal antigen titers than patients without positive urine cultures. Increased mortality was noted in patients with elevated titers of 1 to 8 and urine cultures positive for Candida albicans plus other positive sites than in those with candiduria alone (100 versus 63 per cent, p less than 0.005). In groups 2 and 3 there was a higher mortality rate among patients with candiduria plus other positive sites. The sensitivity of elevated candidal antigen titers in the presence of candiduria and/or multiple positive culture sites was 62.8 per cent, with a specificity of 84 per cent and a predictive value of 68.7 per cent. We conclude that the commercial candidal antigen detection system was a useful laboratory adjunct in the evaluation of the debilitated patient with candiduria.