Combined Assessment of β‐d‐Glucan and Degree of Candida Colonization before Starting Empiric Therapy for Candidiasis in Surgical Patients

Abstract

The purpose of the study was to investigate whether examination for plasma beta-D-glucan, a cell wall constituent of fungi, is useful for selecting surgical patients with Candida colonization who would benefit from empiric antifungal therapy. We administered fluconazole to postoperative patients with Candida colonization who have risk factors for candidemia and complained of persistent fever despite prolonged antibacterial therapy. We then analyzed the clinical outcomes regarding the number of sites colonized with Candida spp. and plasma beta-D-glucan. Of the 32 patients positive for alpha-D-glucan, 15 (46.9%) responded to the empiric therapy; only 9% of those who were negative responded (p < 0.01). In the multiple logistic regression analysis, being positive for alpha-D-glucan was a significant factor predicting response, with an adjusted odds ratio of 12.9 in patients with Candida colonization [95% confidence interval (CI) 2.07-80.73) (p < 0.01). In addition, the number of sites colonized with Candida spp. was a significant factor predicting response, with an estimated exposure odds ratio of 7.57 for those who were colonized at three or more sites compared with those colonized at one site (95% CI 1.20-47.70) (p = 0.031). In patients with Candida colonization, assessment of beta-D-glucan was useful for deciding whether to start empiric therapy for suspected candidiasis in surgical patients.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…Although previous studies have shown the usefulness of BDG for the diagnosis of IC in surgical patients [6,22,25], our findings confirm that BDG is highly specific for a cutoff value of 259 pg/mL but with a very low sensitivity (51.6 %). CAGTA (negative/limit-positive) has a better sensitivity than BDG but its specificity is lower.…”

“…This finding is clinically relevant not only for the population to which the prediction rule can be applied, but also because it is very easy to remember and may help intensivists to decide when to start antifungal treatment. A few studies have investigated the predictive value of BDG on IC in non-neutropenic critically ill patients [21][22][23][24][25]. Elevated concentrations of BDG have been reported to be associated with other fungi, such as Pneumocystis jirovecii infections [26], Gram-positive and Gram-negative bloodstream infections, exposure to gauze or other materials that contain glucans, biofilms on vascular catheters, hemodialysis, and administration of a,b Superscripts indicate significant differences (P \ 0.05) among rates of BDG and positive CAGTA values among the three study groups Fig.…”

“…The reason for ICU admission was medical in 18.8 % of patients, surgical in 76.1 %, and trauma in 5.1 %. The median (IQR) length of ICU and hospital stay was 15 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and 38 (24-57) days, respectively, which were significantly higher in patients with IC compared to the other two groups. ICU and hospital crude mortality rates were 26.7 and 32.4 %, respectively.…”

Contribution of the (1→3)-β- d -Glucan Assay for Diagnosis of Invasive Fungal Infections

“…Among the 12 false M-positive sera, only 3 were BG positive, which indicates less cross-reaction. However, false-positive BG results have been described after hemodialysis on cellulose membrane (18), after contamination by environmental BG (7), after surgery (contamination by gazes), after treatment with immunoglobulin or antitumoral polysaccharides such as lentinan and schizophyllan (29), or during some bacterial infections (23). We observed four positive BG results among six hemodialysis patients and seven other "false BG-positive" results in the group at risk for candidemia.…”

Heterologous Expression of Candida albicans Cell Wall-Associated Adhesins in Saccharomyces cerevisiae Reveals Differential Specificities in Adherence and Biofilm Formation and in Binding Oral Streptococcus gordonii

“…The ability of C. albicans to attach to and colonize mucosal tissues is a risk factor for disseminated candidiasis (25,42), and three of the candidal proteins tested here have already been associated with mediating interactions with host epithelia. Als3p has been shown to function as an invasin, inducing endocytosis and uptake of C. albicans into endothelial and epithelial cells by targeting N-cadherin and E-cadherin, respectively (35).…”