Combined assessment of beta-D-glucan and degree of candida colonization before starting empiric therapy for candidiasis in surgical patients.
The purpose of the study was to investigate whether examination for plasma beta-D-glucan, a cell wall constituent of fungi, is useful for selecting surgical patients with Candida colonization who would benefit from empiric antifungal therapy. We administered fluconazole to postoperative patients with Candida colonization who have risk factors for candidemia and complained of persistent fever despite prolonged antibacterial therapy. We then analyzed the clinical outcomes regarding the number of sites colonized with Candida spp. and plasma beta-D-glucan. Of the 32 patients positive for alpha-D-glucan, 15 (46.9%) responded to the empiric therapy; only 9% of those who were negative responded (p < 0.01). In the multiple logistic regression analysis, being positive for alpha-D-glucan was a significant factor predicting response, with an adjusted odds ratio of 12.9 in patients with Candida colonization [95% confidence interval (CI) 2.07-80.73) (p < 0.01). In addition, the number of sites colonized with Candida spp. was a significant factor predicting response, with an estimated exposure odds ratio of 7.57 for those who were colonized at three or more sites compared with those colonized at one site (95% CI 1.20-47.70) (p = 0.031). In patients with Candida colonization, assessment of beta-D-glucan was useful for deciding whether to start empiric therapy for suspected candidiasis in surgical patients.
Takesue
Yoshio
Y
Department of Surgery, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. takesuey@hiroshima-u.ac.jp
Kakehashi
Masayuki
M
Ohge
Hiroki
H
Imamura
Yuuji
Y
Murakami
Yoshiaki
Y
Sasaki
Masaru
M
Morifuji
Masahiko
M
Yokoyama
Yujiro
Y
Kouyama
Mohei
M
Yokoyama
Takashi
T
Sueda
Taijiro
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota; D002177:Candidiasis / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D005936:Glucans / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000097:blood* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D047071:beta-Glucans
D000935:Antifungal Agents; D005936:Glucans; D047071:beta-Glucans; D015725:Fluconazole; C033363:beta-1,3-glucan