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Candida-Antigen-Titer (CAG-Titer) for Detection and Early Treatment of Impending Candidemia

S Jachec, W Perbix, R Lefering, C Diaz, G Spilker, C Weinand

Background: Candidemia is a life threatening infection with mortality over 20%.

Objective: Despite this there is little consensus on the use of serum-based diagnostics. At our institution we have used candida-antigen-titer (CAG titer) since 25 years for therapeutical decisions.

Methods: In this retrospective study correlation between CAG titer and mortality were evaluated on 945 burn intensive care patients admitted from January 1988 to December 2011. Inclusion criteria were age over 14 years, burn injury and intensive care treatment, no previous treatment outside our institution, at least one CAG titer measured and complete abbreviated burn severity index score (ABSI). Statistical evaluation was performed by uni- and multivariate analysis and the finale model using the SPSS program.

Results: Out of 945 patients 877 were included in the study. Mean age was 42.3 years, male patients were dominant (72.2%). Mean length of stay in the burn intensive care unit was 32.5 days and mean mortality rate was 22%. Increasing mortality was found with increasing CAG titers. This was concordant with increasing ABSI score and increasing total burned surface area (TBSA). Candida species most often detected was candida albicans and parapsilosis. The earliest detected antigens were candida famata and tropicalis. Candida parapsilosis was also detected first in the blood stream. Predicting variables for death were sex, multi-organ failure, age, total burned surface area, antibiotic use and CAG titer > 1:8.

Conclusion: Cut off points in candida titers beyond 1:4 in patients with infection not otherwise explainable offers the opportunity for early antimycotic therapy. Although the latex assay is not a perfect tool to diagnose candidemia in the very early stages, it is a useful armament in our hands to initiate treatment in burn intensive care patient population.