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 .0005 and .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.

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A recently developed pan-Aspergillus PCR assay and GM testing of BAL fluid may facilitate the diagnosis of IPA after lung transplantation. A. fumigatus- and A. terreus-specific real-time PCR assays may be useful in rapidly identifying the most common cause of IPA and a species that is intrinsically resistant to amphotericin B, respectively.

Fifty-six serum posaconazole trough levels were measured in 17 cardiothoracic transplant recipients. Initial levels were <0.5, 0.51 to 0.99, and >1 g/ml for 47, 29, and 24% of patients, respectively. Median trough levels associated with therapeutic success were higher than those associated with failure (1.55 versus 0.34 g/ml; P ‫؍‬ 0.006). Patients with levels consistently >0.5 g/ml were more likely to have successful outcome (P ‫؍‬ 0.055). Age >65 years, oral administration, and absence of proton pump inhibitors were associated with higher levels of posaconazole (P ‫؍‬ 0.006, 0.006, and 0.001, respectively).

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