The (1,3)-β-D-glucan use for invasive candidiasis diagnosis in non-neutropenic critically ill patients: a prospective cohort study

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Published Dec 1, 2024
https://doi.org/10.62438/tunismed.v102i12.5254
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Vol. 102 No. 12 (2024): Tunis Med dec 2024

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Badis Tlili
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Ahlem Trifi
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Aicha Kallel
Parasitology Mycology Department,La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
Asma Mehdi
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Eya Seghir
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Lynda Messaoud
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Kalthoum Kallel
Parasitology Mycology Department,La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunis, Tunisia
Sami Abdellatif
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia
Salah Ben Lakhal
Intensive Care Medicine Department, La Rabta Tertiary Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar,1007, Tunis, Tunisia

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.


Aim: To 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).


Results: A 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%).


Conclusion: The 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.

Keywords:

Beta-Glucans, Invasive Candidiasis, Intensive Care, Diagnosis, Performance

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