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Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India

BACKGROUND: β-d-Glucan assay (BDG) has been recently introduced in India and is recommended for the early diagnosis of invasive candidiasis (IC), but there are a number of factors (eg β-lactam antibiotics, immunoglobulin and albumin infusions, bacteremia and surgical mesh) which may falsely elevate...

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Autores principales: Bansal, Nitin, Gopalakrishnan, Ram, Sethuraman, Nandini
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631234/
http://dx.doi.org/10.1093/ofid/ofx163.1607
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author Bansal, Nitin
Gopalakrishnan, Ram
Sethuraman, Nandini
author_facet Bansal, Nitin
Gopalakrishnan, Ram
Sethuraman, Nandini
author_sort Bansal, Nitin
collection PubMed
description BACKGROUND: β-d-Glucan assay (BDG) has been recently introduced in India and is recommended for the early diagnosis of invasive candidiasis (IC), but there are a number of factors (eg β-lactam antibiotics, immunoglobulin and albumin infusions, bacteremia and surgical mesh) which may falsely elevate BDG levels. METHODS: This was a retrospective, observational study done in the 23 bedded multi-disciplinary ICU of a tertiary care hospital in South India. Case records of adult (> 18 years) non-neutropenic patients having severe sepsis or shock with ≥ 1 risk factor for IC were analyzed. As a standard practice, BDG assay was sent and effective antifungals were started on the day of suspicion of IC. All neutropenic, immunocompromised patients, those already on antifungal and those who were diagnosed with other invasive fungal infections were excluded from the study. FDA approved Fungitell assay was used to measure serum BDG levels (pg/mL). RESULTS: Patients were divided into 3 groups. Group A (n = 16) comprised of patients in whom diagnosis of IC was confirmed (blood culture or another sterile site grew candida). Group B (n = 30) comprised of patients in whom alternative diagnosis of severe sepsis or septic shock was found or they did not improve after administration of antifungals. Group C (n = 31) comprised of those patients in whom neither diagnosis of IC was confirmed nor an alternative explanation was found but they improved clinically on giving antifungal therapy. Mean BDG levels was significantly higher in Group A as compared with Group B and Group C (448.75 ± 88.30 vs 144.46 ± 82.49 vs 292.90 ± 137.0 pg/mL; P < 0.001). The mean value of the BDG was higher than the accepted cutoff of 80 pg/mL in all three groups (Figure 1). The use of agents which cause false elevation of BDG was significantly higher in Group B as compared with Group A (P = 0.02). CONCLUSION: A BDG assay cutoff of 80 pg/mL leads to a higher number of false positive results in ICU patients, where false positive factors are unavoidable. The results of this study suggest that a higher cutoff of at least 144 pg/mL will be more specific for IC, although this may need further validation with larger trials. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-56312342017-11-07 Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India Bansal, Nitin Gopalakrishnan, Ram Sethuraman, Nandini Open Forum Infect Dis Abstracts BACKGROUND: β-d-Glucan assay (BDG) has been recently introduced in India and is recommended for the early diagnosis of invasive candidiasis (IC), but there are a number of factors (eg β-lactam antibiotics, immunoglobulin and albumin infusions, bacteremia and surgical mesh) which may falsely elevate BDG levels. METHODS: This was a retrospective, observational study done in the 23 bedded multi-disciplinary ICU of a tertiary care hospital in South India. Case records of adult (> 18 years) non-neutropenic patients having severe sepsis or shock with ≥ 1 risk factor for IC were analyzed. As a standard practice, BDG assay was sent and effective antifungals were started on the day of suspicion of IC. All neutropenic, immunocompromised patients, those already on antifungal and those who were diagnosed with other invasive fungal infections were excluded from the study. FDA approved Fungitell assay was used to measure serum BDG levels (pg/mL). RESULTS: Patients were divided into 3 groups. Group A (n = 16) comprised of patients in whom diagnosis of IC was confirmed (blood culture or another sterile site grew candida). Group B (n = 30) comprised of patients in whom alternative diagnosis of severe sepsis or septic shock was found or they did not improve after administration of antifungals. Group C (n = 31) comprised of those patients in whom neither diagnosis of IC was confirmed nor an alternative explanation was found but they improved clinically on giving antifungal therapy. Mean BDG levels was significantly higher in Group A as compared with Group B and Group C (448.75 ± 88.30 vs 144.46 ± 82.49 vs 292.90 ± 137.0 pg/mL; P < 0.001). The mean value of the BDG was higher than the accepted cutoff of 80 pg/mL in all three groups (Figure 1). The use of agents which cause false elevation of BDG was significantly higher in Group B as compared with Group A (P = 0.02). CONCLUSION: A BDG assay cutoff of 80 pg/mL leads to a higher number of false positive results in ICU patients, where false positive factors are unavoidable. The results of this study suggest that a higher cutoff of at least 144 pg/mL will be more specific for IC, although this may need further validation with larger trials. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5631234/ http://dx.doi.org/10.1093/ofid/ofx163.1607 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Bansal, Nitin
Gopalakrishnan, Ram
Sethuraman, Nandini
Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title_full Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title_fullStr Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title_full_unstemmed Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title_short Experience with β-d-Glucan Assay for Diagnosis of Invasive Candidiasis in ICU Patients: Pilot Study from India
title_sort experience with β-d-glucan assay for diagnosis of invasive candidiasis in icu patients: pilot study from india
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631234/
http://dx.doi.org/10.1093/ofid/ofx163.1607
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