European Journal of Clinical Microbiology & Infectious Diseases

, Volume 31, Issue 5, pp 721–731

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

  • J. Acosta
  • M. Catalan
  • A. del Palacio-Pérez-Medel
  • J.-C. Montejo
  • J. De-La-Cruz-Bértolo
  • M.-D. Moragues
  • J. Pontón
  • M. A. Finkelman
  • A. del Palacio
Article

DOI: 10.1007/s10096-011-1365-0

Cite this article as:
Acosta, J., Catalan, M., del Palacio-Pérez-Medel, A. et al. Eur J Clin Microbiol Infect Dis (2012) 31: 721. doi:10.1007/s10096-011-1365-0

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.

Supplementary material

10096_2011_1365_MOESM1_ESM.pdf (102 kb)
Online Resource 1Characteristics of patients with proven and probable IFD (n=23) (PDF 102 kb)
10096_2011_1365_MOESM2_ESM.pdf (105 kb)
Online Resource 2Performance of serum GM determination in invasive aspergillosis case patients (PDF 104 kb)
10096_2011_1365_MOESM3_ESM.pdf (73 kb)
Online Resource 3Performance of BG determination in serum (PDF 73 kb)

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • J. Acosta
    • 1
  • M. Catalan
    • 2
  • A. del Palacio-Pérez-Medel
    • 3
  • J.-C. Montejo
    • 2
  • J. De-La-Cruz-Bértolo
    • 4
  • M.-D. Moragues
    • 5
  • J. Pontón
    • 6
  • M. A. Finkelman
    • 7
  • A. del Palacio
    • 1
  1. 1.Department of Medical MicrobiologyHospital Universitario 12 de OctubreMadridSpain
  2. 2.Medical Intensive Care UnitHospital Universitario 12 de OctubreMadridSpain
  3. 3.Department of Internal MedicineHospital Universitario 12 de OctubreMadridSpain
  4. 4.Clinical Epidemiology UnitHospital Universitario 12 de Octubre, Biomedical Research Institute (imas12)MadridSpain
  5. 5.Department of NursingUniversidad del País VascoLeioaSpain
  6. 6.Department of Immunology, Microbiology, and Parasitology, School of Medicine and DentistryUniversidad del País VascoLeioaSpain
  7. 7.Falmouth Technology ParkAssociates of Cape Cod, Inc., East Falmouth, MassachusettsEast FalmouthUSA