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.

Abstract

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.

• Authors: J Acosta, M Catalan, A del Palacio-Pérez-Medel, J-C Montejo, J De-La-Cruz-Bértolo, M-D Moragues, J Pontón, M A Finkelman, A del Palacio
• Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 31 Issue 5 Pg. 721-31 (May 2012) ISSN: 1435-4373 [Electronic] Germany
• PMID: 21811868 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Mannans
• Proteoglycans
• beta-Glucans
• galactomannan
• polysaccharide-K
• Galactose

Topics

• Adult
• Aged
• Aged, 80 and over
• Critical Illness
• Female
• Galactose (analogs & derivatives)
• Humans
• Male
• Mannans (blood)
• Middle Aged
• Mycoses (diagnosis)
• Prospective Studies
• Proteoglycans
• ROC Curve
• Sepsis (diagnosis, microbiology)
• beta-Glucans (blood)