Abstract
IntroductionPrompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy. The poor sensitivity of blood cultures (BCs) has led to the development of fungal glycan tests as a diagnostic adjunct. We analysed the performance of tests for the detection of circulating β-D-1,3-glucan (BDG) and mannan in the intensive care unit (ICU) setting.MethodsThis retrospective, case–control study included 43 ICU patients with candidaemia and 67 controls, hospitalised on the same ward and assessed weekly for yeast colonisation with simultaneous serum sampling; 340 sera taken before and after positive BCs were available for the cases group and 203 for the controls. BDG and mannan levels were determined using the Fungitell® and Platelia™ Candida Ag tests, respectively.ResultsBDG was detected early in sera from cases patients but was also present in several sera from controls. Increasing the cut-off from 80 pg/mL to 350 pg/mL and 800 pg/mL resulted in sensitivity/specificity ratios of 0.97/0.31, 0.65/0.74, 0.30/0.86, respectively. Detection of mannan was more specific but lacked sensitivity. No obvious correlation was found between BDG and colonisation, but a trend existed between high colonisation and high BDG. Candidaemia relapses were associated with a rise in BDG and mannan but, in contrast to the transient nature of mannan, BDG persisted up to 7 weeks after positive BCs.ConclusionA combination of mannan and BDG tests could be used to guide pre-emptive therapeutic decisions in ICU patients.
Highlights
Prompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy
One Candida species was found in blood culture (BC) (Candida albicans in 40.5%, Candida parapsilosis in 23.8%, Candida tropicalis in 19%, Candida glabrata in 16.7%), except for one patient who had both C. albicans and C. parapsilosis
To respond to the questions ‘How can glycanaemia predict the onset of Invasive candidosis (IC)?’ and ‘How can glycanaemia reveal IC?’ we considered the period from day 7 before to day 7 after the first positive BC
Summary
This retrospective, case–control study included 43 ICU patients with candidaemia and 67 controls, hospitalised on the same ward and assessed weekly for yeast colonisation with simultaneous serum sampling; 340 sera taken before and after positive BCs were available for the cases group and 203 for the controls. BDG and mannan levels were determined using the Fungitell® and PlateliaTM Candida Ag tests, respectively. Patients This retrospective, case–control study involved adult patients hospitalised in a 50-bed polyvalent ICU department in a tertiary university teaching hospital. The control group consisted of patients hospitalised on the same ward with Candida colonisation but no evidence of IC; five body sites (urine, anal swabs, nasal swabs, throat and tracheal aspirates when patients were intubated) were sampled once a week for the semi-quantitative determination of yeast colonisation. We looked for evidence of invasive aspergillosis and infection by Pneumocystis jirovecii and excluded patients who had criteria for these two opportunistic fungal infections
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