Prospective survey of (1→3)-beta-D-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting.

Abstract

Non-culture-based diagnostic strategies are needed for diagnosing invasive candidiasis (IC). We evaluated serial serum (1→3)-β-d-glucan (BG) levels in patients in the surgical trauma intensive care unit (SICU) patients with clinical evidence of IC. Serum samples from patients admitted to the SICU for a minimum of 3 days were collected twice weekly and analyzed for BG by using a Fungitell kit with a positive cutoff of ≥ 80 pg/ml. Diagnosis of IC was done using a set of predefined and validated clinical practice-based criteria. A total of 57 patients consented to participate and were enrolled. The median ICU stay was 16 days (range, 3 to 51). A total of 14 of 57 (25%) false positives were observed in the first sample (ICU day 3) and, overall, 73% of the day 3 samples had higher BG levels than subsequent samples. On the date of clinical diagnosis of IC, the sensitivity of a positive BG for identifying invasive candidiasis was 87%, with a 73% specificity. In patients with evidence of IC, the median BG value was significantly higher than those without evidence of IC (171 versus 48 pg/ml, P = 0.02), respectively. In the three patients with proven IC, BG was detected 4 to 8 days prior to diagnosis. BG serum detection may be a useful tool to aid in the early diagnosis of IC in SICU patients, particularly after day 3 and in patients with at least two positive samples drawn several days apart. Elevated BG levels within the first 3 days need to be further characterized.

• Authors: John F Mohr, Charles Sims, Victor Paetznick, Jose Rodriguez, Malcolm A Finkelman, John H Rex, Luis Ostrosky-Zeichner
• Journal: Journal of clinical microbiology (J Clin Microbiol) Vol. 49 Issue 1 Pg. 58-61 (Jan 2011) ISSN: 1098-660X [Electronic] United States
• PMID: 21048005 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Proteoglycans
• beta-Glucans
• polysaccharide-K

Topics

• Adolescent
• Adult
• Aged
• Candidiasis, Invasive (diagnosis)
• Clinical Laboratory Techniques (methods)
• Critical Care
• Female
• Humans
• Male
• Middle Aged
• Proteoglycans
• Sensitivity and Specificity
• Young Adult
• beta-Glucans (blood)