title: Pre-emptive treatment of fungal infection based on plasma β-D-glucan levels after gastric surgery for gastric cancer in elderly patients.
abstract: OBJECTIVE
  Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI.
  
  
  METHODS
  In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study. Patients with plasma βDG levels >11 pg/mL (the cut-off value) were randomly assigned to either receive antifungal treatment or not (n=13 in each group). Postoperative outcomes were assessed using various clinical parameters.
  
  
  RESULTS
  After gastric cancer surgery, plasma βDG levels were ≥11 pg/mL in 26 of 81 elderly patients (32.1%). Of the βDG-positive patients, significantly more had stages III and IV rather than stages I and II disease (44.1% vs 23.4%, respectively; P=0.049). Fever on postoperative day 8 was significantly reduced in the pre-emptive antifungal-treated group than in the control group (36.8°C vs 37.2°C, respectively; P=0.045). However, there were no significant differences in mortality, morbidity, βDG levels, white blood cell count, and C-reactive protein levels between the two groups.
  
  
  CONCLUSIONS
  Pre-emptive antifungal treatment based on βDG after gastric surgery in elderly patients may help reduce the incidence of postoperative fever and suppress IFI. However, this needs to be confirmed in a larger prospective randomized, controlled trial.
authors.affiliation: Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Namikawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Tomoki
authors.initials: T
authors.lastname: Yamatsuji
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Naomoto
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D009181:Mycoses / Q000175:diagnosis / Q000517:prevention & control*; D009367:Neoplasm Staging; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011446:Prospective Studies; D011509:Proteoglycans; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047071:beta-Glucans / Q000097:blood*
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K
keywords: fungal infection; gastric cancer; gastric surgery; pre-emptive treatment