Beta -D-Glucan for Guidance of Antifungal Therapy at the ICU: a retrospective evaluation in a real life setting

Ref ID: 19548

Author:

J Prattes1, J Wagner1, I Zollner-Schwetz1, F Prueller2, R Raggam2, K Seeber1, S Fruhwald3,
T Valentin1, R Krause1, M Hoenigl1*

Author address:

1Section of Infectious Diseases, Medical University of Graz
2Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz
3Department of Anaesthesiology, Medical University of Graz

Full conference title:

6th Advances Against Aspergillosis 2014

Abstract:

Purpose:
Timely diagnosis is a key factor in successful treatment of invasive fungal infections (IFI) at the ICU.
Beta-D-glucan (BDG) is a component of the fungal cell wall of most fungi including Aspergillus
Candida, Fusarium and Pneumocystis. BDG serum testing has been shown to be a useful marker for
early detection and therapy monitoring of IFIs in the ICU. The exact role of BDG in clinical routine/
IFI management remains, however, unclear. The purpose of this study was to evaluate a preemptive
approach with BDG as a marker for guidance of AF in the ICU.
Methods:
ICU patients with clinical suspicion of invasive fungal infections admitted between April 2013 and
September 2013 at the Medical University of Graz, Austria were included in the analysis. All patients
were seen by the Infectious Disease (ID) service and clinical decision was made together with
ICU physicians whether or not to initiate systemic preemptive antifungal therapy (AF) depending
on clinics and candida scores. BDG testing was performed always prior to initiation of antifungal
treatment and in addition to routine diagnostic measures. Beta-D-glucan testing was performed
automatically on the coagulation automat providing results within 24 hours. On the following day
when BDG results were available preemptive antifungal therapy was either discontinued (in case
of negative BDG results, i.e. <60 pg/mL) or initiated/continued (in case of positive results, i.e. >120 pg/mL). BDG testing was repeated in case of results between 60 and 120.
Results:
In total 66 pts were included in the analysis. According to clinical decisions by ID and ICU
physicians preemptive AF were started in 40 pts, while in 26 pts no AF therapy was initiated. One
day later when BDG test results were available BDG results led to discontinuation of preemptive AF
in 13 patients, initiation of AF in 7 patients, while in 46 patients the clinical decision was confirmed
by BDG results (27 pts with AF, 19 patients without AF). While the majority of prabable and proven
IFI cases were predicted by the test, BDG resulted negative in two cases diagnosed later as probable
invasive aspergillosis (diagnosed by BAL GM 4 and 9 days later) and one case of probable invasive
candidiasis (diagnosed 4 days later). In all 3 patients AF would have also not been initiated according
to clinical decision.
Conclusion:
BDG seems to be a promising tool to guide antifungal therapy in ICU patients. Prospective studies
evaluating our IFI management approach are needed to confirm our results.

Abstract Number: 75

Conference Year: 2014

Link to conference website: http://www.AAA2014.org

New link: NULL

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