title: A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.
abstract: The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU).
  
  
  
  A prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined.
  
  
  
  In patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001).
  
  
  
  New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.
authors.affiliation: Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Microbiology Department, St. James's Hospital, Dublin, Ireland. Electronic address: talenta@tcd.ie.
authors.forename: Alida Fe
authors.initials: AF
authors.lastname: Talento
authors.affiliation: Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland.
authors.forename: Katie
authors.initials: K
authors.lastname: Dunne
authors.affiliation: Radiology Department, St. James's Hospital, Dublin, Ireland.
authors.forename: Eimear Ann
authors.initials: EA
authors.lastname: Joyce
authors.affiliation: Public Health England Mycology Reference Laboratory, Bristol, England, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Palmer
authors.affiliation: Public Health England Mycology Reference Laboratory, Bristol, England, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Public Health Wales Microbiology Cardiff, University Hospital of Wales Cardiff, Wales, United Kingdom.
authors.forename: P Lewis
authors.initials: PL
authors.lastname: White
authors.affiliation: University of Wuerzburg Medical Centre, Department for Internal Medicine II, Wuerzburg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Springer
authors.affiliation: University of Wuerzburg Medical Centre, Department for Internal Medicine II, Wuerzburg, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Loeffler
authors.affiliation: Anaesthetics Department, St. James's Hospital, Dublin, Ireland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ryan
authors.affiliation: Anaesthetics Department, St. James's Hospital, Dublin, Ireland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Collins
authors.affiliation: Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Microbiology Department, St. James's Hospital, Dublin, Ireland.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Rogers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D015415:Biomarkers / Q000097:blood*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003422:Critical Care; D004271:DNA, Fungal / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D004271:DNA, Fungal; D047071:beta-Glucans
keywords: (1-3)-β-d-glucan; Critical care patients; Fungal biomarkers; Galactomannan; Invasive fungal disease