title: Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-β-D-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease.
abstract: Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-β-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75-0.99]) and BG (0.856 [95% CI, 0.71-0.99]) were compared (p = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39-0.82) and 0.768 (95% CI, 0.63-0.90) respectively. Positive BG (40%) predated blood culture (n = 3) and abdominal pus (n = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD.
authors.affiliation: Department of Medical Microbiology, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Acosta
authors.forename: M
authors.initials: M
authors.lastname: Catalan
authors.forename: A
authors.initials: A
authors.lastname: del Palacio-Pérez-Medel
authors.forename: J-C
authors.initials: JC
authors.lastname: Montejo
authors.forename: J
authors.initials: J
authors.lastname: De-La-Cruz-Bértolo
authors.forename: M-D
authors.initials: MD
authors.lastname: Moragues
authors.forename: J
authors.initials: J
authors.lastname: Pontón
authors.forename: M A
authors.initials: MA
authors.lastname: Finkelman
authors.forename: A
authors.initials: A
authors.lastname: del Palacio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D008351:Mannans / Q000097:blood*; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis*; D011446:Prospective Studies; D011509:Proteoglycans; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology*; D047071:beta-Glucans / Q000097:blood*
chemical_list: D008351:Mannans; D011509:Proteoglycans; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose