Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1→3)-β-D-glucan assay, Candida score, and colonization index

Brunella Posteraro, Gennaro De Pascale, Mario Tumbarello, Riccardo Torelli, Mariano Alberto Pennisi, Giuseppe Bello, Riccardo Maviglia, Giovanni Fadda, Maurizio Sanguinetti, Massimo Antonelli, Brunella Posteraro, Gennaro De Pascale, Mario Tumbarello, Riccardo Torelli, Mariano Alberto Pennisi, Giuseppe Bello, Riccardo Maviglia, Giovanni Fadda, Maurizio Sanguinetti, Massimo Antonelli

Abstract

Introduction: The culture-independent serum (1→3)-β-D-glucan (BG) detection test may allow early diagnosis of invasive fungal disease, but its clinical usefulness needs to be firmly established. A prospective single-center observational study was conducted to compare the diagnostic value of BG assay, Candida score (CS), and colonization index in intensive care unit (ICU) patients at risk for Candida sepsis.

Methods: Of 377 patients, consecutively admitted to ICU for sepsis, 95 patients having an ICU stay of more than five days were studied. Blood specimens for fungal culture and BG measurement were obtained at the onset of clinical sepsis. For CS and colonization index calculations, surveillance cultures for Candida growth, and/or clinical data were recorded.

Results: Sixteen (16.8%) patients were diagnosed with proven invasive fungal infection, 14 with candidiasis (13 candidemia and 1 mediastinitis) and 2 with pulmonary aspergillosis or fusariosis. Of 14 invasive Candida-infection patients, 13 had a serum sample positive for BG, 10 had a CS value ≥ 3, and 7 a colonization index ≥ 0.5. In the 12 candidemic patients, a positive BG result was obtained 24 to 72 hrs before a culture-documented diagnosis of invasive candidiasis. The positive and negative predictive values for the BG assay were higher than those of CS and colonization index (72.2% versus 57.1% and 27.3%; and 98.7% versus 97.2% and 91.7%, respectively).

Conclusions: A single-point BG assay based on a blood sample drawn at the sepsis onset, alone or in combination with CS, may guide the decision to start antifungal therapy early in patients at risk for Candida infection.

Figures

Figure 1
Figure 1
Flow chart of the study patients. ICU, intensive care unit; IFI, invasive fungal infection.
Figure 2
Figure 2
(BG results of sera from two blood sampling sites for subjects with or without IC.
Figure 3
Figure 3
ROC AUC curves of BG, CS, and colonization index for proven IC cases. [The AUC of BG was significantly higher than those of CS (P < 0.001) and colonization index (P < 0.001), please edit this sentence as a footnote].

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