Skip to main content

Advertisement

Log in

Can fungal biomarkers be used to improve antifungal therapy in the intensive care unit?

  • Published:
Current Fungal Infection Reports Aims and scope Submit manuscript

Abstract

Invasive fungal infections have an increasing incidence worldwide, and patients in intensive care settings are particularly vulnerable to them. Candidemia is the third most common bloodstream pathogen in intensive care units (ICUs) in the United States, and a number of reports have recently been published regarding the increasing incidence of invasive aspergillosis in ICUs throughout the world. Because research has shown that early antifungal therapy is associated with better outcomes, clinicians are starting to explore new diagnostic fungal markers, which are more sensitive and faster than the traditional diagnostic standards of culture and histopathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Pfaller MA, Diekema DJ: Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev 2007, 20:133–163.

    Article  PubMed  CAS  Google Scholar 

  2. Richardson M, Lass-Florl C: Changing epidemiology of systemic fungal infections. Clin Microbiol Infect 2008, 4:5–24.

    Article  Google Scholar 

  3. Wisplinghoff H, Bischoff T, Tallent SM, et al.: Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004, 39:309–317.

    Article  PubMed  Google Scholar 

  4. Meersseman W, Van Wijngaerden E: Invasive aspergillosis in the ICU: an emerging disease. Intensive Care Med 2007, 33:1679–1681.

    Article  PubMed  Google Scholar 

  5. Meersseman W, Lagrou K, Maertens J, et al.: Invasive aspergillosis in the intensive care unit. Clin Infect Dis 2007, 45:205–216.

    Article  PubMed  Google Scholar 

  6. Samarakoon P, Soubani AO: Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature. Chron Respir Dis 2008, 5:19–27.

    Article  PubMed  CAS  Google Scholar 

  7. Chamilos G, Lewis RE, Kontoyiannis DP: Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008, 47:503–509.

    Article  PubMed  Google Scholar 

  8. Garey KW, Rege M, Pai MP, et al.: Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 2006, 43:25–31.

    Article  PubMed  CAS  Google Scholar 

  9. Kedzierska A: (1 → 3)-beta-D-glucan—a new marker for the early serodiagnosis of deep-seated fungal infections in humans. Pol J Microbiol 2007, 56:3–9.

    PubMed  CAS  Google Scholar 

  10. Odabasi Z, Paetznick VL, Rodriguez JR, et al.: Differences in beta-glucan levels in culture supernatants of a variety of fungi. Med Mycol 2006, 44:267–272.

    Article  PubMed  CAS  Google Scholar 

  11. Obayashi T, Tamura H, Tanaka S, et al.: A new chromogenic endotoxin-specific assay using recombined limulus coagulation enzymes and its clinical applications. Clin Chim Acta 1985, 149:55–65.

    Article  PubMed  CAS  Google Scholar 

  12. Kitagawa T, Tsuboi I, Kimura S, et al.: Rapid method for preparing a beta-glucan-specific sensitive fraction from Limulus (Tachypleus tridentatus) amebocyte lysate. J Chromatogr 1991, 567:267–273.

    Article  PubMed  CAS  Google Scholar 

  13. Ostrosky-Zeichner L, Alexander BD, Kett DH, et al.: Multicenter clinical evaluation of the (1→3) beta-D-glucan assay as an aid to diagnosis of fungal infections in humans. Clin Infect Dis 2005, 41:654–659.

    Article  PubMed  CAS  Google Scholar 

  14. Pazos C, Ponton J, Del Palacio A: Contribution of (1→3)-beta-D-glucan chromogenic assay to diagnosis and therapeutic monitoring of invasive aspergillosis in neutropenic adult patients: a comparison with serial screening for circulating galactomannan. J Clin Microbiol 2005, 43:299–305.

    Article  PubMed  CAS  Google Scholar 

  15. Obayashi T, Negishi K, Suzuki T, et al.: Reappraisal of the serum (1→3)-beta-D-glucan assay for the diagnosis of invasive fungal infections—a study based on autopsy cases from 6 years. Clin Infect Dis 2008, 46:1864–1870.

    Article  PubMed  CAS  Google Scholar 

  16. Odabasi Z, Mattiuzzi G, Estey E, et al.: Beta-D-glucan as a diagnostic adjunct for invasive fungal infections: validation, cutoff development, and performance in patients with acute myelogenous leukemia and myelodysplastic syndrome. Clin Infect Dis 2004, 39:199–205.

    Article  PubMed  CAS  Google Scholar 

  17. Ohata A, Usami M, Horiuchi T, et al.: Release of (1→3)-beta-D-glucan from depth-type membrane filters and their in vitro effects on proinflammatory cytokine production. Artif Organs 2003, 27:728–735.

    Article  PubMed  CAS  Google Scholar 

  18. Mennink-Kersten MA, Ruegebrink D, Verweij PE: Pseudomonas aeruginosa as a cause of 1,3-beta-D-glucan assay reactivity. Clin Infect Dis 2008, 46:1930–1931.

    Article  PubMed  Google Scholar 

  19. Marty FM, Lowry CM, Lempitski SJ, et al.: Reactivity of (1→3)-beta-d-glucan assay with commonly used intravenous antimicrobials. Antimicrob Agents Chemother 2006, 50:3450–3453.

    Article  PubMed  CAS  Google Scholar 

  20. Kanamori H, Kanemitsu K, Miyasaka T, et al.: Measurement of (1–3)-beta-D-glucan derived from different gauze types. Tohoku J Exp Med 2009, 217:117–121.

    Article  PubMed  CAS  Google Scholar 

  21. Nakao A, Yasui M, Kawagoe T, et al.: False-positive endotoxemia derives from gauze glucan after hepatectomy for hepatocellular carcinoma with cirrhosis. Hepatogastroenterology 1997, 44:1413–1418.

    PubMed  CAS  Google Scholar 

  22. Nakamura H, Tateyama M, Tasato D, et al.: Clinical utility of serum beta-D-glucan and KL-6 levels in Pneumocystis jiroveci pneumonia. Intern Med 2009, 48:195–202.

    Article  PubMed  Google Scholar 

  23. Marty FM, Koo S, Bryar J, et al.: (1→3)beta-D-glucan assay positivity in patients with Pneumocystis (carinii) jiroveci pneumonia. Ann Intern Med 2007, 147:70–72.

    PubMed  Google Scholar 

  24. Akamatsu N, Sugawara Y, Kaneko J, et al.: Preemptive treatment of fungal infection based on plasma (1 → 3)beta-D-glucan levels after liver transplantation. Infection 2007, 35:346–351.

    Article  PubMed  CAS  Google Scholar 

  25. Maertens J, Theunissen K, Lodewyck T, et al.: Advances in the serological diagnosis of invasive Aspergillus infections in patients with haematological disorders. Mycoses 2007, 50(Suppl 1):2–17.

    Article  PubMed  CAS  Google Scholar 

  26. Pfeiffer CD, Fine JP, Safdar N: Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006, 42:1417–1427.

    Article  PubMed  CAS  Google Scholar 

  27. Singh N, Obman A, Husain S, et al.: Reactivity of platelia Aspergillus galactomannan antigen with piperacillintazobactam: clinical implications based on achievable concentrations in serum. Antimicrob Agents Chemother 2004, 48:1989–1992.

    Article  PubMed  CAS  Google Scholar 

  28. Fortun J, Martin-Davila P, Alvarez ME, et al.: False-positive results of Aspergillus galactomannan antigenemia in liver transplant recipients. Transplantation 2009, 87:256–260.

    Article  PubMed  Google Scholar 

  29. Kedzierska A, Kochan P, Pietrzyk A, et al.: Current status of fungal cell wall components in the immunodiagnostics of invasive fungal infections in humans: galactomannan, mannan and (1→3)-beta-D-glucan antigens. Eur J Clin Microbiol Infect Dis 2007, 26:755–766.

    Article  PubMed  CAS  Google Scholar 

  30. Maertens J, Theunissen K, Verhoef G, et al.: False-positive Aspergillus galactomannan antigen test results. Clin Infect Dis 2004, 39:289–290.

    Article  PubMed  Google Scholar 

  31. Mennink-Kersten MA, Ruegebrink D, Klont RR, et al.: Bifidobacterial lipoglycan as a new cause for false-positive platelia Aspergillus enzyme-linked immunosorbent assay reactivity. J Clin Microbiol 2005, 43:3925–3931.

    Article  PubMed  CAS  Google Scholar 

  32. Penack O, Rempf P, Graf B, et al.: False-positive Aspergillus antigen testing due to application of piperacillin/tazobactam—is it still an issue? Diagn Microbiol Infect Dis 2008, 60:117–120.

    PubMed  CAS  Google Scholar 

  33. Maertens JA, Klont R, Masson C, et al.: Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay. Clin Infect Dis 2007, 44:1329–1336.

    Article  PubMed  CAS  Google Scholar 

  34. Takesue Y, Kakehashi M, Ohge H, et al.: Combined assessment of beta-D-glucan and degree of candida colonization before starting empiric therapy for candidiasis in surgical patients. World J Surg 2004, 28:625–630.

    Article  PubMed  Google Scholar 

  35. Maertens J, Theunissen K, Verhoef G, et al.: Galactomannan and computed tomography-based preemptive antifungal therapy in neutropenic patients at high risk for invasive fungal infection: a prospective feasibility study. Clin Infect Dis 2005, 41:1242–1250.

    Article  PubMed  CAS  Google Scholar 

  36. Schuster MG, Edwards JE Jr, Sobel JD, et al.: Empirical fluconazole versus placebo for intensive care unit patients: a randomized trial. Ann Intern Med 2008, 149:83–90.

    PubMed  Google Scholar 

  37. Maertens J, Buve K, Theunissen K, et al.: Galactomannan serves as a surrogate endpoint for outcome of pulmonary invasive aspergillosis in neutropenic hematology patients. Cancer 2009, 115:355–362.

    Article  PubMed  Google Scholar 

  38. Miceli MH, Grazziutti ML, Woods G, et al.: Strong correlation between serum aspergillus galactomannan index and outcome of aspergillosis in patients with hematological cancer: clinical and research implications. Clin Infect Dis 2008, 46:1412–1422.

    Article  PubMed  Google Scholar 

  39. Imhof A, Schaer C, Schoedon G, et al.: Rapid detection of pathogenic fungi from clinical specimens using LightCycler real-time fluorescence PCR. Eur J Clin Microbiol Infect Dis 2003, 22:558–560.

    Article  PubMed  CAS  Google Scholar 

  40. Dendis M, Horvath R, Michalek J, et al.: PCR-RFLP detection and species identification of fungal pathogens in patients with febrile neutropenia. Clin Microbiol Infect 2003, 9:1191–1202.

    Article  PubMed  CAS  Google Scholar 

  41. Ruhnke M, Scheer C, Hanfler J, et al.: Diagnosis of Aspergillosis from bronchoalveolar lavage samples by combining a mechanical DNA extraction and a Taq-Man-based realtime PCR [abstract M-904]. Presented at the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, CA; September 27–30, 2002.

  42. Seyfarth F, Ziemer M, Sayer HG, et al.: The use of ITS DNA sequence analysis and MALDI-TOF mass spectrometry in diagnosing an infection with Fusarium proliferatum. Exp Dermatol 2008, 17:965–971.

    Article  PubMed  CAS  Google Scholar 

  43. Sendid B, Jouault T, Coudriau R, et al.: Increased sensitivity of mannanemia detection tests by joint detection of alpha- and beta-linked oligomannosides during experimental and human systemic candidiasis. J Clin Microbiol 2004, 42:164–171.

    Article  PubMed  CAS  Google Scholar 

  44. Sendid B, Caillot D, Baccouch-Humbert B, et al.: Contribution of the Platelia Candida-specific antibody and antigen tests to early diagnosis of systemic Candida tropicalis infection in neutropenic adults. J Clin Microbiol 2003, 41:4551–4558.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Luis Ostrosky-Zeichner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ostrosky-Zeichner, L. Can fungal biomarkers be used to improve antifungal therapy in the intensive care unit?. Curr Fungal Infect Rep 3, 147–151 (2009). https://doi.org/10.1007/s12281-009-0019-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12281-009-0019-5

Keywords

Navigation