Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-β-D-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease

Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-β-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and...

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Published in:European journal of clinical microbiology & infectious diseases 2012-05, Vol.31 (5), p.721-731
Main Authors: Acosta, J., Catalan, M., del Palacio-Pérez-Medel, A., Montejo, J.-C., De-La-Cruz-Bértolo, J., Moragues, M.-D., Pontón, J., Finkelman, M. A., del Palacio, A.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aspergillosis
Aspergillus
beta-Glucans - blood
Biological and medical sciences
biomarkers
Biomedical and Life Sciences
Biomedicine
Blood culture
Candida
Candidiasis
Critical Illness
Female
Hematologic and hematopoietic diseases
Humans
Infectious diseases
Internal Medicine
Male
Mannans - blood
Medical Microbiology
Medical sciences
Middle Aged
Molds
Mycelia
Mycoses - diagnosis
Nuclear polyhedrosis virus
Other diseases. Hematologic involvement in other diseases
Prospective Studies
ROC Curve
Sepsis - diagnosis
Sepsis - microbiology
Zygomycosis
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Summary:Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-β-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75–0.99]) and BG (0.856 [95% CI, 0.71–0.99]) were compared ( p  = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39–0.82) and 0.768 (95% CI, 0.63–0.90) respectively. Positive BG (40%) predated blood culture ( n  = 3) and abdominal pus ( n  = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-011-1365-0