title: β-glucan antigenemia anticipates diagnosis of blood culture-negative intraabdominal candidiasis.
abstract: BACKGROUND
  Life-threatening intraabdominal candidiasis (IAC) occurs in 30 to 40% of high-risk surgical intensive care unit (ICU) patients. Although early IAC diagnosis is crucial, blood cultures are negative, and the role of Candida score/colonization indexes is not established.
  
  
  OBJECTIVE
  The aim of this prospective Fungal Infection Network of Switzerland (FUNGINOS) cohort study was to assess accuracy of 1,3-β-d-glucan (BG) antigenemia for diagnosis of IAC.
  
  
  METHODS
  Four hundred thirty-four consecutive adults with abdominal surgery or acute pancreatitis and ICU stay 72 hours or longer were screened: 89 (20.5%) at high risk for IAC were studied (68 recurrent gastrointestinal tract perforation, 21 acute necrotizing pancreatitis). Diagnostic accuracy of serum BG (Fungitell), Candida score, and colonization indexes was compared.
  
  
  RESULTS
  Fifty-eight of 89 (65%) patients were colonized by Candida; 29 of 89 (33%) presented IAC (27 of 29 with negative blood cultures). Nine hundred twenty-one sera were analyzed (9/patient): median BG was 253 pg/ml (46-9,557) in IAC versus 99 pg/ml (8-440) in colonization (P < 0.01). Sensitivity and specificity of two consecutive BG measurements greater than or equal to 80 pg/ml were 65 and 78%, respectively. In recurrent gastrointestinal tract perforation it was 75 and 77% versus 90 and 38% (Candida score ≥ 3), 79 and 34% (colonization index ≥ 0.5), and 54 and 63% (corrected colonization index ≥ 0.4), respectively. BG positivity anticipated IAC diagnosis (5 d) and antifungal therapy (6 d). Severe sepsis/septic shock and death occurred in 10 of 11 (91%) and 4 of 11 (36%) patients with BG 400 pg/ml or more versus 5 of 18 (28%, P = 0.002) and 1 of 18 (6%, P = 0.05) with BG measurement less than 400 pg/ml. β-Glucan decreased in IAC responding to therapy and increased in nonresponse.
  
  
  CONCLUSIONS
  BG antigenemia is superior to Candida score and colonization indexes and anticipates diagnosis of blood culture-negative IAC. This proof-of-concept observation in strictly selected high-risk surgical ICU patients deserves investigation of BG-driven preemptive therapy.
authors.affiliation: 1 Infectious Diseases Service, Department of Medicine.
authors.forename: Frederic
authors.initials: F
authors.lastname: Tissot
authors.forename: Frederic
authors.initials: F
authors.lastname: Lamoth
authors.forename: Philippe M
authors.initials: PM
authors.lastname: Hauser
authors.forename: Christina
authors.initials: C
authors.lastname: Orasch
authors.forename: Ursula
authors.initials: U
authors.lastname: Flückiger
authors.forename: Martin
authors.initials: M
authors.lastname: Siegemund
authors.forename: Stefan
authors.initials: S
authors.lastname: Zimmerli
authors.forename: Thierry
authors.initials: T
authors.lastname: Calandra
authors.forename: Jacques
authors.initials: J
authors.lastname: Bille
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Oscar
authors.initials: O
authors.lastname: Marchetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D015331:Cohort Studies; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007416:Intestinal Perforation / Q000150:complications; D059413:Intraabdominal Infections / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D055815:Young Adult; D047071:beta-Glucans / Q000276:immunology*
chemical_list: D047071:beta-Glucans; C033363:beta-1,3-glucan