Combined use of serum (1,3)-β-d-glucan and procalcitonin for the early differential diagnosis between candidaemia and bacteraemia in intensive care units

Abstract

BackgroundThis study aimed to assess the combined performance of serum (1,3)-β-d-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy.MethodsFrom June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR–). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan’s nomograms.ResultsOne hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases.ConclusionsThe combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1763-5) contains supplementary material, which is available to authorized users.

Soluble Intercellular Adhesion Molecule- (sICAM-) 1, Thrombospondin-1, and Vinculin for the Identification of Septic Shock Patients Suffering from an Invasive Fungal Infection

“…This will hopefully be associated with the following most appreciated side effects: (1) primary cost savings (e.g., due to the waiving of expensive antifungal drugs and reduced hospital and ICU stay) and (2) reducing drug resistance rates (with secondary cost savings). Although the combined use of BDG and PCT was recently described to be suitable for early differential diagnosis between candidemia and bacteremia in intensive care units [22], the diagnostic value of BDG for IFI diagnosis is not free of doubts and subject of controversial discussions [37][38][39][40]. In line with that, BDG recently failed to be a suitable biomarker for reliable IFI diagnosis in septic shock within the presented cohort [21].…”

“…Common diagnostic procedures for the identification of patients suffering from an IFI (such as culture-based diagnostics or plasma levels of β-D-glucan (BDG)) are associated with relevant weaknesses, so that a considerable number of IFI cases might be missed [20][21][22]. Moreover, this diagnostic insufficiency is associated with a delayed initiation of antifungal therapy, associated with the abovementioned increased mortality rates [23].…”

Significance of G Test [(1-3)-β-D-Glucan Assay] in the Diagnosis and Guidance of Clinical Medication of Invasive Fungal Infection

“…Clinical diagnosis of IFI mainly consisted of four parts: host factors (preventive treatment), clinical characteristics (empirical treatment), microbiological examination (preemptive treatment) and histopathology (pathogen treatment) [7]. Histopathological examination was the "gold standard" for the diagnosis of IFI, but as an invasive examination, it had been restricted in clinical practice [10]. Compared with the time-consuming and low detection rate of fungal culture [11], as a unique microbiological detection method for fungal infection [12], G test had the advantages of being specific, fast and accurate.…”

“…Elevated levels of (1-3)-β-D-glucan in blood and other sterile body fluids indicated IFI, most commonly caused by aspergillus and candida. Therefore, G test [(1-3)-β-D-glucan assay] in the blood of patients can be used as an early predictor of IFI [10,15,16]. In this study, when positive fungal culture was used as the criterion for the diagnosis of IFI, the sensitivity, specificity, positive predictive value and negative predictive value of G test for the diagnosis of IFI were 87.04%, 79.25%, 63.09% and 93.75%, respectively.…”

Developing definitions for invasive fungal diseases in critically ill adult patients in intensive care units. Protocol of the FUNgal infections Definitions in ICU patients (FUNDICU) project

“…[8][9][10] Possible alternative diagnostic algorithms for ICU patients have been proposed. [11][12][13][14][15][16] We report here the steps we will implement to develop a standard set of definitions for IFD in critically ill patients in ICU, starting from a systematic assessment of the strengths and limitations of the definitions and algorithms already available in the literature.…”