Does Treatment Affect the Levels of Serum 946;-D-glucan (BD) in the Treatment of Invasive Candidiasis (IC) ?

Ref ID: 18760

Author:

K. Nakajima, MD,PhD – Lecture, Y. Takesue, MD,PhD – Professor, K. Ichiki, ICN – head nurse, T. Ueda, MS – pharmacist, M. Komatsu, ICN – nurse, Y. Wada, ICMT – chief, T. Tsuchida, PhD – associate professor, Y. Takahashi, Mis – pharmacist;

Author address:

Hyogo college of Med., Nishinomiya, Japan.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: The BDG assay in serum is a useful tool to start antifungal empirical therapy in patients with suspected IC. The objective of this study was to investigate the impact of follow-up monitoring of BDG in the assessment of efficacy of antifugal therapy. Methods: IC patients with baseline BDG positive in whom follow-up BDG were measured were evaluated. The baseline data was defined as BDG level obtained before start of either 1st line therapy or alternative therapy in patients without clinical response of preceding antifungals. A cutoff value for a positive BDG level was set at 11.0 pg/ml (dilution & heating-turbidimetric method, Wako β -Glucan assay) . Result: 105 patients (87 patients with determined IC including 34 candidemia, and 18 patients who had empirical antifungal therapy) were experienced between Jun 2006 and Dec 2011. Median duration of BDG follow-up until the completion of therapy was 19.0 days. The positive rate of BDG was 61.9% (70.6% in candinemia). Treatment success was achieved in 79.0% of patients. BDG did not decrease in patients with clinical failure or indeterminate cases, (245.0±236.7 vs. 260.1±294.3 pg/ml, P=0.94). In patients with clinical success, however, there was a significant difference in BDG between baseline and at the completion of therapy (n=54, 128.6±171.2 vs. 43.0±57.2 pg/ml, P<0.001). 32 of 54 patients (59.3%) revealed a BD decrease of more than 50% from baseline. In patients in whom initial follow-up BDG data were available on day 7 (n=49), BDG had already decreased significantly compared with baseline (107.4±148.2 vs. 51.1±79.4 pg/ml, P<0.001). BDG became negative at the completion of therapy in 11 of 54 patients with clinical success (20.4%). Among 43 patients in whom BDG remained positive at completion of therapy, recurrence of IC occurred in only two patients (4.7%). Conclusions: Follow-up monitoring of BDG appears to be useful in evaluating the therapeutic efficacy in certain patients with IC. However the reduction to less than standard value at the completion of therapy was not required.

Abstract Number: M-1687

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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