Abstract
IntroductionThe culture-independent serum (1→3)-β-D-glucan (BG) detection test may allow early diagnosis of invasive fungal disease, but its clinical usefulness needs to be firmly established. A prospective single-center observational study was conducted to compare the diagnostic value of BG assay, Candida score (CS), and colonization index in intensive care unit (ICU) patients at risk for Candida sepsis.MethodsOf 377 patients, consecutively admitted to ICU for sepsis, 95 patients having an ICU stay of more than five days were studied. Blood specimens for fungal culture and BG measurement were obtained at the onset of clinical sepsis. For CS and colonization index calculations, surveillance cultures for Candida growth, and/or clinical data were recorded.ResultsSixteen (16.8%) patients were diagnosed with proven invasive fungal infection, 14 with candidiasis (13 candidemia and 1 mediastinitis) and 2 with pulmonary aspergillosis or fusariosis. Of 14 invasive Candida-infection patients, 13 had a serum sample positive for BG, 10 had a CS value ≥3, and 7 a colonization index ≥0.5. In the 12 candidemic patients, a positive BG result was obtained 24 to 72 hrs before a culture-documented diagnosis of invasive candidiasis. The positive and negative predictive values for the BG assay were higher than those of CS and colonization index (72.2% versus 57.1% and 27.3%; and 98.7% versus 97.2% and 91.7%, respectively).ConclusionsA single-point BG assay based on a blood sample drawn at the sepsis onset, alone or in combination withCS, may guide the decision to start antifungal therapy early in patients at risk for Candida infection.
Highlights
The culture-independent serum (1®3)-b-D-glucan (BG) detection test may allow early diagnosis of invasive fungal disease, but its clinical usefulness needs to be firmly established
BG rises before infection becomes clinically apparent [16,17], but the high false-positive rates [19,20] make it necessary to refine its utility as a tool for the early diagnosis of invasive fungal infections (IFIs) [15]
Of 377 patients with clinical signs of sepsis admitted to the intensive care unit (ICU) during the study period, 95 who fulfilled the inclusion criteria above specified were enrolled as participants (Figure 1)
Summary
The culture-independent serum (1®3)-b-D-glucan (BG) detection test may allow early diagnosis of invasive fungal disease, but its clinical usefulness needs to be firmly established. Measurement of the serum (1®3)-b-D-glucan (BG) is a non-invasive testing for circulating fungal cell wall components [14], that allows the systematic screening and prompt identification of fungal infections (with the exception of cryptococcosis and zygomycosis) [15]. This test is considered an aid for the diagnosis of fungemia and deep-seated mycoses including IC [16,17,18], and it appears to be useful for patients with hematological malignancies [16,17]. BG rises before infection becomes clinically apparent [16,17], but the high false-positive rates [19,20] make it necessary to refine its utility as a tool for the early diagnosis of invasive fungal infections (IFIs) [15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
