Prospective survey of (1→3)-beta-D-glucan and its relationship to invasive candidiasis in the surgical intensive care unit setting.
Non-culture-based diagnostic strategies are needed for diagnosing invasive candidiasis (IC). We evaluated serial serum (1→3)-β-d-glucan (BG) levels in patients in the surgical trauma intensive care unit (SICU) patients with clinical evidence of IC. Serum samples from patients admitted to the SICU for a minimum of 3 days were collected twice weekly and analyzed for BG by using a Fungitell kit with a positive cutoff of ≥ 80 pg/ml. Diagnosis of IC was done using a set of predefined and validated clinical practice-based criteria. A total of 57 patients consented to participate and were enrolled. The median ICU stay was 16 days (range, 3 to 51). A total of 14 of 57 (25%) false positives were observed in the first sample (ICU day 3) and, overall, 73% of the day 3 samples had higher BG levels than subsequent samples. On the date of clinical diagnosis of IC, the sensitivity of a positive BG for identifying invasive candidiasis was 87%, with a 73% specificity. In patients with evidence of IC, the median BG value was significantly higher than those without evidence of IC (171 versus 48 pg/ml, P = 0.02), respectively. In the three patients with proven IC, BG was detected 4 to 8 days prior to diagnosis. BG serum detection may be a useful tool to aid in the early diagnosis of IC in SICU patients, particularly after day 3 and in patients with at least two positive samples drawn several days apart. Elevated BG levels within the first 3 days need to be further characterized.
Division of Infectious Diseases, University of Texas Health Science Center at Houston, 6431 Fannin, MSB 2.112, Houston, TX 77030, USA.
John F
JF
Mohr
Charles
C
Sims
Victor
V
Paetznick
Jose
J
Rodriguez
Malcolm A
MA
Finkelman
John H
JH
Rex
Luis
L
Ostrosky-Zeichner
D000293:Adolescent; D000328:Adult; D000368:Aged; D058365:Candidiasis, Invasive / Q000175:diagnosis*; D019411:Clinical Laboratory Techniques / Q000379:methods; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011509:Proteoglycans; D012680:Sensitivity and Specificity; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K