title: (1,3)-β-d-Glucan-based antifungal treatment in critically ill adults at high risk of candidaemia: an observational study.
abstract: To determine the effects of a strategy that uses serum (1,3)-β-d-glucan (BDG) results for antifungal treatment of ICU patients at high risk of invasive candidiasis.
  
  
  
  Adult patients admitted to the ICU from January 2012 to June 2014 were included if they exhibited sepsis at the time of BDG testing and they met Candida score components ≥3. A retrospective analysis of collected data was performed.
  
  
  
  In total, 198 patients were studied. Of 63 BDG-positive patients, 47 with candidaemia and 16 with probable Candida infection, all [31.8% (63/198)] received antifungal therapy. Of 135 BDG-negative patients, 110 [55.5% (110/198)] did not receive antifungal therapy, whereas 25 [12.6% (25/198)] were initially treated. Overall, antifungal therapy was started in 88 cases (44.4%), mostly with echinocandins. Antifungals were discontinued in 14 of 25 patients, as negative BDG results became available, and in 16 BDG-false-positive patients for whom subsequent findings allowed candidaemia (and other forms of invasive candidiasis) to be ruled out. Candidaemia was diagnosed only in one patient who did not receive prior antifungal therapy. The median antifungal therapy duration in candidaemic patients differed significantly from that in non-candidaemic patients [14 (IQR, 6-18) days versus 4 (IQR, 3-7) days; P < 0.001]. Using this approach, antifungal therapy was avoided in ∼73% of potentially treatable patients and it was shortened in another ∼20%.
  
  
  
  This study supports the use of serum BDG results in the management of systemic antifungal drug prescription in septic patients. These findings need to be confirmed in additional studies.
authors.affiliation: Institute of Public Health (Section of Hygiene), Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Brunella
authors.initials: B
authors.lastname: Posteraro
authors.affiliation: Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: De Pascale
authors.affiliation: Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Liberto
authors.affiliation: Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maria S
authors.initials: MS
authors.lastname: Vallecoccia
authors.affiliation: Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Carolis
authors.affiliation: Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Gravio
authors.affiliation: Institute of Infectious Diseases, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Trecarichi
authors.affiliation: Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy maurizio.sanguinetti@unicatt.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.affiliation: Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000097:blood*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000188:drug therapy*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011509:Proteoglycans; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy* / Q000209:etiology*; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K