title: Serum 1,3-beta-d-glucan for antifungal treatment stratification at the intensive care unit and the influence of surgery.
abstract: The purpose of this study was to evaluate a preemptive approach with serum 1,3-beta-d-glucan (BDG) as a marker for treatment stratification of systemic antifungal (AF) therapy in patients with clinical suspected invasive fungal infections (IFI) at intensive care units (ICU), and the impact of surgical procedures. A total of 66 ICU patients with clinical suspected IFI were included in this retrospective analysis. Serum BDG testing was performed prior to initiation of AF treatment and in addition to routine diagnostic measures. Based on the BDG results the initial clinical decision whether or not to start systemic AF therapy was re-evaluated. Impact of surgical procedures on clinical utility of serum BDG was evaluated in a sub-group of 25 patients who had undergone surgical procedures prior to BDG evaluation. BDG test results led to discontinuation of AF therapy in 13 patients, and initiation of AF therapy in seven patients. In 46 patients the clinical decision was confirmed by BDG. The majority of suspected, probable and proven IFI cases (10/13, 77%) was predicted by the test. BDG testing turned out positive in 9/25 (36%) of patients that had undergone recent surgery and levels correlated with clinical findings. Serum BDG evaluation seems to be a promising tool to guide AF therapy in ICU patients even after recent surgical procedures.
authors.affiliation: Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Prattes
authors.forename: Martin
authors.initials: M
authors.lastname: Hoenigl
authors.forename: Jasmin
authors.initials: J
authors.lastname: Rabensteiner
authors.forename: Reinhard B
authors.initials: RB
authors.lastname: Raggam
authors.forename: Florian
authors.initials: F
authors.lastname: Prueller
authors.forename: Ines
authors.initials: I
authors.lastname: Zollner-Schwetz
authors.forename: Thomas
authors.initials: T
authors.lastname: Valentin
authors.forename: Katharina
authors.initials: K
authors.lastname: Hönigl
authors.forename: Sonja
authors.initials: S
authors.lastname: Fruhwald
authors.forename: Robert
authors.initials: R
authors.lastname: Krause
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001230:Aspergillus / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
chemical_list: D000935:Antifungal Agents; D047071:beta-Glucans; C033363:beta-1,3-glucan
keywords: 1,3-Beta-d-glucan; antifungal therapy; intensive care unit; serum; surgery