Experience with β-D-Glucan assay in the management of critically ill patients with high risk of invasive candidiasis: An observational study
Year: 2018
Type: article
Study design: Observational Study
Abstract: Brief Communication IntroductIonCandida bloodstream infection (candidemia) or invasive candidiasis (IC) in Intensive Care Units (ICU) is associated with great morbidity and mortality.[1] The situation is no different in India: in a multicentric study, the 30-day crude and attributable mortality rates were 44.7 and 19.6%, respectively.[2] These high mortality rates highlight the fact that diagnosis of IC is often missed which leads to mortality.Although blood culture is the gold standard for diagnosis of candidemia, it suffers from low sensitivity (50%) and longer turnaround time (2-4 days).[3] As blood cultures are insensitive and time-consuming, diagnosis of IC is often based on clinical suspicion, candidal score, and Candida colonization index, none of which are sensitive or specific; it has been estimated that up to 70% of patients who receive empiric antifungal agents do not have proven candidal infection.[4] (1,3)-β-D-glucan (BDG) is a cell wall polysaccharide found in almost all pathogenic fungi with exception of zygomycetes and Cryptococcus.[5] BDG assay has been utilized in the early diagnosis of IC/candidemia and also has a high negative predictive value (NPV) and therefore can be utilized for stopping empirical antifungal therapy.[5] The BDG assay has recently been introduced in India and the clinical efficacy data of BDG in Indian ICUs are lacking.We retrospectively analyzed BDG data to determine the effect of utilizing it in stopping or de-escalating antifungal therapy in Indian settings. MethodsThis was a retrospective study conducted in a 24-bed ICU of a tertiary care center in South India.Records of patients for which BDG assay (October 2016-August 2017) was requested were analyzed for basic parameters, candidal score, BDG value, duration and type of antifungal agent Background: The (1,3)-β-D-glucan assay (BDG) is recommended for the early diagnosis of invasive candidiasis (IC).Methods: Records of 154 critically ill adults with suspected IC, on whom BDG was done, were analyzed.Patients were divided into three groups: Group A (confirmed IC), Group B (alternative diagnosis or cause of severe sepsis), and Group C (high candidal score and positive BDG [>80 pg/mL] but without a confirmed diagnosis of IC).Results: Mean BDG levels were significantly higher in Group A (n = 32) as compared to Group B (n = 60) and Group C (n = 62) (448.75 ± 88.30 vs. 144.46± 82.49 vs. 292.90± 137.0 pg/mL; P < 0.001).Discontinuation of empiric antifungal therapy based on a value <80 resulted in cost savings of 14,000 INR per day per patient.Conclusion: A BDG value of <80 pg/ml facilitates early discontinuation of empirical antifungal therapy, with considerable cost savings.
Authors: R. Madhumitha, V. Ramasubramanian, P. Nambi, D. Kumar, M.A. Thirunarayan
Institutions: Apollo Hospitals, Apollo Hospitals
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2804023955