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

León, Cristóbal; Ruiz‐Santana, Sergio; Saavedra, Pedro; Castro, Carmen; Úbeda, Alejandro; Loza, Ana; Martín-Mazuelos, Estrella; Blanco, Armando; Jerez, Vicente; Ballús, J.; Álvarez–Rocha, Luis; Utande-Vázquez, Aránzazu; Fariñas, Osvaldo

doi:10.1007/s00134-012-2616-y

Cited by 88 publications

(48 citation statements)

References 30 publications

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“…In the challenging scenario of early diagnosis of IC, recent studies have demonstrated the diagnostic value of BDG and CAGTA [19,[38][39][40][41][42]. Although the use of BDG measurement in daily practice for establishing the indication or the withdrawal of ESAT should be defined, recent observational studies [41,42] showed that negativity of the BDG assay may be used as a strategy to discontinue ESAT because of the high sensitivity and negative predictive value of the test.…”

Section: Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…If the WBP or serum was also PCR negative, then the posttest probability of IA was 0% (Fig. 2) (19,20). The highest specificity for a single PCR was associated with testing WBP (96%), but sensitivity was compromised (55%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Performance Characteristics of Aspergillus PCR in Testing a Range of Blood-Based Samples in Accordance with International Methodological Recommendations

et al. 2016

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cStandardized methodologies for the molecular detection of invasive aspergillosis (IA) have been established by the European Aspergillus PCR Initiative for the testing of whole blood, serum, and plasma. While some comparison of the performance of Aspergillus PCR when testing these different sample types has been performed, no single study has evaluated all three using the recommended protocols. Standardized Aspergillus PCR was performed on 423 whole-blood pellets (WBP), 583 plasma samples, and 419 serum samples obtained from hematology patients according to the recommendations. This analysis formed a bicenter retrospective anonymous case-control study, with diagnosis according to the revised European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus definitions (11 probable cases and 36 controls). Values for clinical performance using individual and combined samples were calculated. For all samples, PCR positivity was significantly associated with cases of IA (for plasma, P ‫؍‬ 0.0019; for serum, P ‫؍‬ 0.0049; and for WBP, P ‫؍‬ 0.0089). Plasma PCR generated the highest sensitivity (91%); the sensitivities for serum and WBP PCR were 80% and 55%, respectively. The highest specificity was achieved when testing WBP (96%), which was significantly superior to the specificities achieved when testing serum (69%, P ‫؍‬ 0.0238) and plasma (53%, P ‫؍‬ 0.0002). No cases were PCR negative in all specimen types, and no controls were PCR positive in all specimens. This study confirms that Aspergillus PCR testing of plasma provides robust performance while utilizing commercial automated DNA extraction processes. Combining PCR testing of different blood fractions allows IA to be both confidently diagnosed and excluded. A requirement for multiple PCR-positive plasma samples provides similar diagnostic utility and is technically less demanding. Time to diagnosis may be enhanced by testing multiple contemporaneously obtained sample types. Standardized methodologies for the molecular detection of invasive aspergillosis (IA) when testing whole blood (WB), serum, and plasma have been established by the European Aspergillus PCR Initiative (EAPCRI), but direct comparisons of performance for methods compliant with the recommendations are limited (1-8). The published evidence from the data generated is contradictory. Serum was shown to be superior to the cell pellet in one study, only for another to recommend the use of WB over plasma (4,5). A recent study showed no significant difference in PCR performance when testing serum or WB (6). Differences between the methodologies used in the studies, particularly sample volumes and DNA extraction protocols, make comparisons difficult, and if suboptimal methods were used for one particular sample type, the assay performance and conclusions could be biased (1, 2).It is important to compare the different specimen types using optimal methodology and to co...

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“…However, the vast majority of these patients are referred from surgical wards in which candida colonization surveillance is rarely performed, transferred from other institutions, or even urgently re-admitted. Fungal biomarkers such as b-D-glucan might be of interest to identify those patients who really need to be treated [12,13], while procalcitonin assays appear to be fairly disappointing [13]. Unfortunately, these assays are not yet routinely performed and their value in this specific subpopulation is still under investigation.…”

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confidence: 99%

Intra-abdominal candidiasis: it’s still a long way to get unquestionable data

2015

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Intra-abdominal candidiasis (IAC) appears as the second most frequent cause of invasive fungal infection in the intensive-care unit (ICU) [1]. In the AmarCand 1 study, a prospective, multicenter, French observational study, IAC was observed in 34 % of ICU patients with proven invasive candidiasis [1]. Intra-abdominal candidiasis accounts for more than 10 % of all cases of peritonitis and is associated with mortality rates between 25 and 60 % [2,3].Intra-abdominal candidiasis shares many similarities with candidaemia, including conventional risk factors [4] and high morbidity and mortality rates [2,3,5]. While the need for early and adequate antifungal treatment of candidaemia has been clearly demonstrated, no clinical study has ever assessed the need to treat IAC, raising the question of the real pathogenicity of these organisms.Based on the demonstration that delayed antifungal treatment in candidaemia is a factor of poor prognosis, empirical broad-spectrum antifungal treatment is routinely prescribed in IAC. Interestingly, American and European guidelines do not address this issue while the IDSA guidelines for intra-abdominal infections give only weak therapeutic recommendations [6].Recently, a consensus of multinational experts proposed enhanced recommendations for the management of IAC [7]. Using these criteria, Bassetti et al., in an article recently published in Intensive Care Medicine, reported a retrospective international cohort of 481 patients treated for IAC [8]. The authors should be congratulated for the largest cohort of IAC ever published and for the interesting data presented here. Their results deserve some comments to emphasize the complexity for organizing studies on this topic.Despite their attempt to obtain a homogeneous cohort, there is room for improvement in future trials. Their study population gathered together different clinical situations (secondary and tertiary peritonitis, abdominal abscesses, pancreatitis, etc.) in patients with very different underlying diseases and medical history (hospitalized in ICU and surgical wards but also in medical wards, hematology, oncology, etc.) with different levels of severity (with or without septic shock) related to community-acquired, health care-associated and hospital-acquired infections. Overall, a 49.5 % mortality rate was observed in ICU patients compared to 22.8 % in non-ICU patients. Not surprisingly, septic shock and high APACHE II score appeared as independent predictors of mortality, all the more so in patients with these life-threatening conditions who were not all admitted in ICU.A second important issue in the manuscript of Bassetti et al. is the strong correlation between inadequate source control and increased mortality [8]. These findings confirm what some of the authors have recently published [9]. Interestingly, the issue of source control is a matter of

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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

Cited by 88 publications

References 30 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Comparison of Performance Characteristics of Aspergillus PCR in Testing a Range of Blood-Based Samples in Accordance with International Methodological Recommendations

Intra-abdominal candidiasis: it’s still a long way to get unquestionable data

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