Abstract
BackgroundAsymptom of invasive candidiasis (IC) and low positive rate of blood culture lead to delay diagnose of neonatal infection. Serum (1,3)-β-D-glucan (BDG) performs well in adult IC, but its use in neonatal IC is unclear. We evaluated the use of BDG, procalcitonin (PCT), high-sensitive C-reactive protein (hsCRP) or platelet count (PC) in neonatal IC.MethodsWe collected the data of neonates admitted to our institute. Eighty neonates were enrolled, and divided into IC group, bacterial infection (BI) group and control (CTRL) group. We analyzed the difference of these indicators between groups, and generated Receiver operator characteristic (ROC) curve. The value of BDG in antifungal therapy efficacy assessment was also investigated.ResultsThe BDG level was higher in IC group compared with BI and CTRL group. C. albicans lead to significant increase of BDG compared with C. parapsilosis. IC group had highest hsCRP level and lowest PC. PCT level was similar between groups. ROC showed that BDG or hsCRP performs well in neonatal IC, the optimal cut-off for BDG was 13.69 mg/ml. Combined BDG with hsCRP, PCT and PC increased diagnostic value. Serum BDG level was decreased during antifungal treatment.ConclusionSerum BDG performs well in identification of neonatal IC and in monitoring the antifungal therapy efficacy.
Highlights
Asymptom of invasive candidiasis (IC) and low positive rate of blood culture lead to delay diagnose of neonatal infection
We investigated the value of BDG, PCT, high-sensitive C-reactive protein (hsCRP) and platelet count (PC) alone or combined in diagnosing candidaemia, and the Receiver operator characteristic (ROC) curve of each indicator was generated to get the cut-off value
The subjects were separated as IC (30 subjects), bacterial infection (BI) (25 subjects) and CTRL (25 subjects) group according to the result of blood culture
Summary
Asymptom of invasive candidiasis (IC) and low positive rate of blood culture lead to delay diagnose of neonatal infection. Serum (1,3)-β-D-glucan (BDG) performs well in adult IC, but its use in neonatal IC is unclear. Especially the preterm one, are at high risk of invasive infection due to immaturity of immune system, high permeability of skin and mucosal, invasive medical care and prophylaxis antibiotic use. Fungus is one of the most causative pathogens of neonatal invasive infections. Different fungus species could lead to invasive infection, but Yeast especially Candida spp. is the dominant isolated pathogens of invasive fungal infection. BDG is the component of the cell wall of many fungus species and the detection of serum BDG level could be used to diagnose the IC. Serum BDG level performs well in adult patients in intensive care units and onco-hematology
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