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Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital
Background Invasive fungal infections (IFI) are associated with high mortality. Serum fungal biomarkers offer an advantage over the traditional methods in early diagnosis and better clinical outcomes. The aim of the study was to evaluate the role of (1–3)-β-D-glucan (BDG) assay in the patients susp...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473937/ https://www.ncbi.nlm.nih.gov/pubmed/36119434 http://dx.doi.org/10.1055/s-0042-1742632 |
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author | Sandhar, Tanureet Kaur Chhina, Deepinder Kaur Gupta, Veenu Chaudhary, Jyoti |
author_facet | Sandhar, Tanureet Kaur Chhina, Deepinder Kaur Gupta, Veenu Chaudhary, Jyoti |
author_sort | Sandhar, Tanureet Kaur |
collection | PubMed |
description | Background Invasive fungal infections (IFI) are associated with high mortality. Serum fungal biomarkers offer an advantage over the traditional methods in early diagnosis and better clinical outcomes. The aim of the study was to evaluate the role of (1–3)-β-D-glucan (BDG) assay in the patients suspected of IFI. Materials and Methods This prospective study was conducted in the Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, over a period of 1 year. A total of 862 serum samples were received from patients suspected of IFI, for the BDG test (Fungitell, Associates of Cape Cod Inc., USA). The test was performed as per kit protocol. Appropriate samples were processed for KOH fungal smear and fungal culture. Blood culture was done by Bactec (Biomerieux). Statistical Analysis Results were analyzed using descriptive statistical methods. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated at different cutoffs. In addition, the receiver operating characteristic (ROC) curve using SPSS 21.00 software was calculated and the diagnostic accuracy was shown by the area under the ROC curve (AUC). Results Among 862 patients, 546 (63.3%) were males. The predominant age group (25.6%) was between 61 and 70 years. The most common risk factor (54.8%) was prolonged intensive care unit stay. Out of the total samples, 455 (52.8%) samples were found positive for BDG. Fungal elements were seen in 48 (10.5%) KOH smears and fungal growth was obtained in 81 (17.8%) cultures. Comparison of BDG assay and culture at different cutoffs yielded AUC—0.823. Sensitivity (100%), specificity (51.3%), accuracy (55.6%), PPV (15.8%), and NPV (100%) were observed at the kit cutoff of 80 pg/mL. Optimum sensitivity and specificity of 79.2% and 70.3%, respectively, were observed at a cutoff of 142.4pg/mL. A significant correlation was observed between BDG positivity and piperacillin–tazobactam use and dialysis. Among BDG positive patients, 38(8.4%) succumbed to death. Conclusion Detection of BDG helps in the early diagnosis of IFI in critically ill patients. As the assay has a high NPV, a negative test can be used to stop the empirical antifungal drugs. The use of a higher cutoff can be useful to avoid false-positive results. |
format | Online Article Text |
id | pubmed-9473937 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94739372022-09-15 Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital Sandhar, Tanureet Kaur Chhina, Deepinder Kaur Gupta, Veenu Chaudhary, Jyoti J Lab Physicians Background Invasive fungal infections (IFI) are associated with high mortality. Serum fungal biomarkers offer an advantage over the traditional methods in early diagnosis and better clinical outcomes. The aim of the study was to evaluate the role of (1–3)-β-D-glucan (BDG) assay in the patients suspected of IFI. Materials and Methods This prospective study was conducted in the Department of Microbiology, Dayanand Medical College and Hospital, Ludhiana, over a period of 1 year. A total of 862 serum samples were received from patients suspected of IFI, for the BDG test (Fungitell, Associates of Cape Cod Inc., USA). The test was performed as per kit protocol. Appropriate samples were processed for KOH fungal smear and fungal culture. Blood culture was done by Bactec (Biomerieux). Statistical Analysis Results were analyzed using descriptive statistical methods. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated at different cutoffs. In addition, the receiver operating characteristic (ROC) curve using SPSS 21.00 software was calculated and the diagnostic accuracy was shown by the area under the ROC curve (AUC). Results Among 862 patients, 546 (63.3%) were males. The predominant age group (25.6%) was between 61 and 70 years. The most common risk factor (54.8%) was prolonged intensive care unit stay. Out of the total samples, 455 (52.8%) samples were found positive for BDG. Fungal elements were seen in 48 (10.5%) KOH smears and fungal growth was obtained in 81 (17.8%) cultures. Comparison of BDG assay and culture at different cutoffs yielded AUC—0.823. Sensitivity (100%), specificity (51.3%), accuracy (55.6%), PPV (15.8%), and NPV (100%) were observed at the kit cutoff of 80 pg/mL. Optimum sensitivity and specificity of 79.2% and 70.3%, respectively, were observed at a cutoff of 142.4pg/mL. A significant correlation was observed between BDG positivity and piperacillin–tazobactam use and dialysis. Among BDG positive patients, 38(8.4%) succumbed to death. Conclusion Detection of BDG helps in the early diagnosis of IFI in critically ill patients. As the assay has a high NPV, a negative test can be used to stop the empirical antifungal drugs. The use of a higher cutoff can be useful to avoid false-positive results. Thieme Medical and Scientific Publishers Pvt. Ltd. 2022-02-09 /pmc/articles/PMC9473937/ /pubmed/36119434 http://dx.doi.org/10.1055/s-0042-1742632 Text en The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Sandhar, Tanureet Kaur Chhina, Deepinder Kaur Gupta, Veenu Chaudhary, Jyoti Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title | Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title_full | Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title_fullStr | Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title_full_unstemmed | Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title_short | Role of (1-3)-Β-D-Glucan Test in the Diagnosis of Invasive Fungal Infections among High-Risk Patients in a Tertiary Care Hospital |
title_sort | role of (1-3)-β-d-glucan test in the diagnosis of invasive fungal infections among high-risk patients in a tertiary care hospital |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9473937/ https://www.ncbi.nlm.nih.gov/pubmed/36119434 http://dx.doi.org/10.1055/s-0042-1742632 |
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