Abstract
Objective: G test [(1-3) -β-D-glucan assay] was a novel texting method for invasive fungal infection (IFI). The study evaluated the diagnostic value of G test for IFI by comparing G test with fungal culture method，and analyze the guiding significance of G test and fungal culture in clinical medication. Methods: 373 inpatients with suspected IFI in the first affiliated hospital of Jinan university from January to December 2017 were retrospectively analyzed. G test and fungal culture results were collected, and their positive rate, sensitivity, specificity, positive and negative predictive values were calculated. The value and rationality of G test for clinical diagnosis of IFI was evaluated by taking the relief and cure of infection symptoms of patients as clinical effective criteria. Results: Among 373 suspected IFI patients, the positive rate of G experiment was 39.95%, higher than that of fungus culture (28.95%, P<0.001). The positive rate of combined G test and fungal culture was 43.70%. To evaluate the consistency of G test with fungal culture method, κ value was 0.596 (P<0.001). When positive fungal culture was used as the criterion for the diagnosis of IFI, the sensitivity, specificity, positive predictive value and negative predictive value of G test for the diagnosis of IFI were 87.04%, 79.25%, 63.09% and 93.75%, respectively. All 373 patients with IFI received antifungal therapy, and the effective rate of the both methods positive group was 72.34%, higher than 42.86% in the only fungal culture positive group (P=0.033) and 30.48% in the both methods negative group (P<0.001). The effective rate of the only G test positive group was 58.18%, higher than that of the both methods negative group (30.48%, P<0.001). There was no significant difference in the therapeutic efficiency between the only G test positive group and the only fungal culture positive group (P=0.303). Conclusion: G test was an effective diagnostic method of IFI, and combined with fungal culture could improve its positive rate and have a higher guiding value for clinical medication.
Highlights
With extensive solid organ and hematopoietic stem cell transplantation, as well as the extensive use of corticosteroids, broad-spectrum antibiotics, tumor chemotherapy drugs and many kinds of catheter intervention, the prevalence of invasive fungal infections (IFI) sharply increased [1], which was a common cause of morbidity and mortality of immunocompromised patients
There was no significant difference in the therapeutic efficiency between the only G test positive group and the only fungal culture positive group (P=0.303, Table 2, Figure 3)
When positive fungal culture was used as the criterion for the diagnosis of IFI, the sensitivity, specificity, positive predictive value and negative predictive value of G test for the diagnosis of IFI were 87.04%, 79.25%, 63.09% and 93.75%, respectively
Summary
With extensive solid organ and hematopoietic stem cell transplantation, as well as the extensive use of corticosteroids, broad-spectrum antibiotics, tumor chemotherapy drugs and many kinds of catheter intervention, the prevalence of invasive fungal infections (IFI) sharply increased [1], which was a common cause of morbidity and mortality of immunocompromised patients. Since the clinical manifestation of IFI was nonspecific and clinical diagnosis was very difficult, it could lead to misdiagnosis and missed diagnosis, resulting in the increased mortality in severe. This study will explore the clinical value of G test in early diagnosis of IFI by comparing the results of G test and fungal culture in suspected IFI patients, and analyze the guiding significance of G test and fungal culture in clinical medication
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