ArticleLa Tunisie medicale2024
The (1,3)-β-D-glucan use for invasive candidiasis diagnosis in non-neutropenic critically ill patients: a prospective cohort study.
Article in La Tunisie medicale, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction Invasive candidiasis (IC) is a widespread infection in intensive care. As culture-based diagnostic techniques take several days before positivity and leaks of sensitivity. (1,3)-β-D-glucan (BDG) was proposed as a mycological criterion for IC diagnosis in selected patients.
aimTo determine the performance of BDG assay in the early diagnosis of IC in non-neutropenic critically ill patients Methods: We conducted a prospective evaluative study. All adults who were hospitalized in La Rabta Tertiary Hospital intensive care unit from January to June 2023 and at risk of IC were screened on a weekly basis. A true positive status corresponded to confirmed or highly probable IC and a positive BDG test (>80 pg/mL).
resultsA total of 123 BDG tests were performed on 85 patients with a median age of 58 years [41.5-67.5] and a median SOFA score=3 [2-5.5]. The median colonization index was 0.16 [0-0.33], and Candida albicans was the most common species isolated (71%). The median Candida score was 0.9 [0-2.9]. IC was retained in 30 cases. The median BDG level was 98 pg/mL [24-275]. Sixty-one patients had a positive BDG test, in whom only 21 had an IC. The performance of the BDG test in the diagnosis of IC was moderate (AUC/ROC=0.68 [0.575-0.788], p=0.003). The discriminatory power was better with the negative prediction (PNV=85.5%).
conclusionThe major benefit of BDG test in intensive care seems to lie in its NPV allowing to roll out the invasive candidiasis diagnosis then withhold or interrupt antifungal therapy.
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