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

Author: 

Talento AF, Dunne K, Joyce EA, Palmer M, Johnson E, White PL, Springer J, Loeffler J, Ryan T, Collins D, Rogers TR.
J Crit Care. 2017 Mar 30;40:119-127.

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.

Copyright © 2017 Elsevier Inc. All rights reserved.

KEYWORDS:

(1-3)-β-d-glucan; Critical care patients; Fungal biomarkers; Galactomannan; Invasive fungal disease