title: Invasive fungal infections and (1,3)-beta-D-glucan serum concentrations in long-term intensive care patients.
abstract: OBJECTIVE
  Invasive fungal infections are associated with high morbidity and increased mortality. This study was performed to assess the epidemiology of fungal infections and to determine (1,3)-beta-D-glucan serum concentrations in patients admitted to intensive care units (ICUs).
  
  
  METHODS
  Overall 197 patients were admitted to nine medical and surgical intensive care units (ICUs) at a 2200-bed university hospital during a 3-month period. Retrospectively, the patients were split into three groups: group A comprised 24 patients with proven invasive fungal infections admitted for a median of 40 days. Group B comprised 58 patients who were admitted to the ICU for 30 days but without fungal infection. One hundred and fifteen post-operative patients served as controls (group C). The levels of (1,3)-beta-D-glucan were monitored in all patients twice weekly during their ICU admittance.
  
  
  RESULTS
  Average (1,3)-beta-D-glucan concentrations were significantly higher in the patients with fungal infections compared to group B and group C (median 44 vs. 22 and 12.9 pg/ml, respectively; p<0.001). For a serum (1,3)-beta-D-glucan level of 40 pg/ml, the sensitivity, the specificity, the positive predictive value, the negative predictive value, the area under the curve of the receiver operating characteristics (AUC ROC) curve, the likelihood ratio (LR)+ and LR- were 52.2, 75.9, 46.2, 80, 0.7, 2.16, and 0.63, respectively, on day 7. Patients in group A had bacterial infections significantly more often than patients in group B (p=0.003). The hospitalization before ICU admittance for group A was significantly longer than for groups B and C (median 19 (group A) vs. 6 (group B) vs. 10 (group C) days; p<0.05).
  
  
  CONCLUSIONS
  Longer hospitalization and multiple bacterial infections were found to be the main risk factors for invasive fungal infections. Long-term ICU patients have elevated (1,3)-beta-D-glucan levels, not only due to invasive fungal infections, but also due to the serious underlying diseases and conditions, inter-current complications, and intensive care measures. Yet, persistently high serum levels of (1,3)-beta-D-glucan in ICU patients may be indicative of invasive fungal infections and warrant additional diagnostic efforts.
authors.affiliation: Department of Medicine I, Division of Infectious Diseases, Medical University of Vienna-Allgemeines Krankenhaus, Waehringer Guertel 18-20, 1090 Vienna, Austria. elisabeth.presterl@meduniwien.ac.at
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
authors.forename: Bernhard
authors.initials: B
authors.lastname: Parschalk
authors.forename: Edith
authors.initials: E
authors.lastname: Bauer
authors.forename: Andrea
authors.initials: A
authors.lastname: Lassnigg
authors.forename: Stefan
authors.initials: S
authors.lastname: Hajdu
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Graninger
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D001230:Aspergillus / Q000145:classification / Q000302:isolation & purification; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011237:Predictive Value of Tests; D011509:Proteoglycans; D047071:beta-Glucans / Q000097:blood*
chemical_list: D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K