Objectives: Diagnosis of invasive candidiasis (IC) is challenging. Invasive diagnostic procedures are precluded in haematological patients and traditional microbiologic techniques have low sensitivity. (1-3)-íŸ- D-glucan (BG) assay is a non-invasive diagnostic tool that may increase the diagnosis of IC. Methods: BG detection was performed at the discretion of the clinical haematological team. We prospectively assessed the serum levels of BG assay in patients with a compatible clinical syndrome or either at risk for IC. Conventional microbiologic methods, tissue biopsies, blood cultures and necropsies together with the assessment of risk factors, signs, symptoms and radiologic imaging were used for the diagnosis of IC as defined by De Pauw et al (Clin Infect Dis 2008; 46: 1813). Patients were stratified as proposed by Prentice et al (Br J Haematol 2000; 110: 273). ROC curves were used for defining the best BG cutoff. Results: 98 patients (181 episodes) were included in the study. The distribution of episodes in relationship with the risk group was: high risk (n = 72); intermediate high (n = 21); intermediate low (n = 71) and low (n = 17). The prevalence of IC was 5.10%. With a BG cutoff of 80 pg/mL the sensitivity, specificity, positive and negative predictive values were 80, 64.52, 10.81 and 98.36% respectively. Conclusions: The high negative predictive value of BG can exclude reasonably IC in haematological patients even though 80% of patients in our cohort were treated prophylactically with antifungals. In our population the best cutoff for the diagnosis of IC was 80 pg/mL. Acknowledgments: This investigation was supported by grants Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Proyecto Investigacion PI 070134 (to MSC), PI 070107 (to A d P) and PI 070376 (to JP), grant IT-26407 of Departamento de Educacion, Universidades e Investigacion del Gobierno Vasco (to JP) and Saiotek from Departamento de Industria, Comercio y Turismo del Gobierno Vasco (to JP) and an Educational grant from Pfizer (to A d P) and Gilead Spain (to A d P).
Full conference title:
20th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 20th (2010)