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A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit.

Abstract：

PURPOSE:The diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU). METHODS:A prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined. RESULTS:In patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001). CONCLUSION:New diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Talento AF,Dunne K,Joyce EA,Palmer M,Johnson E,White PL,Springer J,Loeffler J,Ryan T,Collins D,Rogers TR

doi

10.1016/j.jcrc.2017.03.025

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

119-127

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(16)31024-3

journal_volume

40

pub_type

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