1. Prospective study in critically ill non-neutropenic patients: diagnostic potential of (1,3)-β-D-glucan assay and circulating galactomannan for the diagnosis of invasive fungal disease
- Author
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Mercedes Catalán, Juan Carlos Montejo, M. A. Finkelman, José Pontón, Joshi Acosta, A. del Palacio-Peréz-Medel, María-Dolores Moragues, A. del Palacio, and J. De-La-Cruz-Bértolo
- Subjects
Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,beta-Glucans ,Critical Illness ,Neutropenia ,Aspergillosis ,Gastroenterology ,Mannans ,Galactomannan ,chemistry.chemical_compound ,Sepsis ,Intensive care ,Internal medicine ,medicine ,Humans ,Blood culture ,Prospective Studies ,Prospective cohort study ,Aged ,Aged, 80 and over ,Leukopenia ,medicine.diagnostic_test ,business.industry ,Galactose ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Infectious Diseases ,Mycoses ,ROC Curve ,chemistry ,Female ,Proteoglycans ,Zygomycosis ,medicine.symptom ,business - Abstract
Diagnosis of invasive fungal disease (IFD) in patients under intensive care is challenging. Circulating biomarkers, (1,3)-β-D-glucan (BG) and galactomannan (GM), were prospectively assessed in 98 critically ill patients at risk of IFD. There were 11 cases of invasive aspergillosis (IA; 4 proven and 7 probable), 9 cases of proven invasive candidiasis (IC), 1 case of mixed proven IC and probable IA, 1 case of proven zygomycosis, and 1 case of mixed mycelial proven IFD. In all IA cases there was no significant difference when the area under the receiver operating characteristic curve (AUC) of GM (0.873 [95%CI, 0.75-0.99]) and BG (0.856 [95% CI, 0.71-0.99]) were compared (p = 0.871). The AUC for BG in IC and for the rest of the IFD cases was 0.605 (95% CI, 0.39-0.82) and 0.768 (95% CI, 0.63-0.90) respectively. Positive BG (40%) predated blood culture (n = 3) and abdominal pus (n = 1) a mean of 3.25 days before Candida was grown. In patients with IFD caused by molds, BG appeared a mean of 5.65 days before culture results. For the diagnosis of patients at risk of IC, BG has shown a high NPV (94.5%), with positive results also predating blood cultures in 30% of patients. In conclusion, early BG results permit a timely initiation of antifungal therapy in patients at risk of IFD.
- Published
- 2011