Abstract
BackgroundWhile Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-D-glucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected Candida pneumonia in immunocompromised and critically ill patients.MethodsThis prospective, observational study enrolled immunocompromised, critically ill, and ventilated patients with suspected fungal pneumonia in mixed intensive care units from November 2010 to October 2011. Patients with D-glucan confounding factors or other fungal infection were excluded. Endotracheal aspirate, bronchoalveolar lavage fluid and serum were collected from each patient to perform a fungal smear, culture, and D-glucan assay.ResultsAfter screening 166 patients, 31 patients completed the study and were categorized into non-Candida pneumonia/non-candidemia (n = 18), suspected Candida pneumonia (n = 9), and non-Candida pneumonia/candidemia groups (n = 4). D-glucan levels in endotracheal aspirate or bronchoalveolar lavage were highest in suspected Candida pneumonia, while the serum D-glucan level was highest in non-Candida pneumonia/candidemia. In all patients, the D-glucan value in endotracheal aspirate was positively correlated with that in bronchoalveolar lavage fluid. For the detection of suspected Candida pneumonia, the predictive performance (sensitivity/specificity/D-glucan cutoff [pg/ml]) of D-glucan in endotracheal aspirate and bronchoalveolar lavage fluid was 67%/82%/120 and 89%/86%/130, respectively, accounting for areas under the receiver operating characteristic curve of 0.833 and 0.939 (both P < 0.05), respectively. Measuring serum D-glucan was of no diagnostic value (area under curve =0.510, P = 0.931) for the detection of suspected Candida pneumonia in the absence of concurrent candidemia.ConclusionsD-glucan levels in both endotracheal aspirate and bronchoalveolar lavage, but not in serum, provide good diagnostic values to detect suspected Candida pneumonia and to serve as potential biomarkers for early detection in this patient population.
Highlights
While Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking
The final diagnoses were categorized as non-Candida pneumonia (CP)/non-candidemia (n = 18, 58.1%), suspected CP (n = 9, 29.0%), or non-CP/candidemia (n = 4, 12.9%) (Fig. 1)
All suspected CP cases demonstrated yeast evidence based on transbronchial lung biopsy (TBLB) histopathology and/or bronchoalveolar lavage (BAL) fungal staining, and they had significantly higher Candida culture rates in BAL (Table 1)
Summary
While Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-Dglucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected Candida pneumonia in immunocompromised and critically ill patients. Candida pneumonia (CP) is life-threatening and has been associated with a high attributable mortality [1]. Growth of respiratory Candida spp. in immunocompromised, cancer-afflicted, and critically ill patients is frequently found, but it is usually considered colonization rather than CP [5]. The presence of respiratory Candida spp. has been shown to be associated with increased bacterial pneumonia development [13,14,15,16], selection of multidrug-resistant bacteria [17], and worse ICU outcomes [14, 18,19,20]. Measurements of biomarkers with diagnostic value for the early detection of suspected CP are urgently needed
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