Presence of Candida cell wall derived polysaccharides in the sera of intensive care unit patients: relation with candidaemia and Candida colonisation
نویسندگان
چکیده
INTRODUCTION Prompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy. The poor sensitivity of blood cultures (BCs) has led to the development of fungal glycan tests as a diagnostic adjunct. We analysed the performance of tests for the detection of circulating β-D-1,3-glucan (BDG) and mannan in the intensive care unit (ICU) setting. METHODS This retrospective, case-control study included 43 ICU patients with candidaemia and 67 controls, hospitalised on the same ward and assessed weekly for yeast colonisation with simultaneous serum sampling; 340 sera taken before and after positive BCs were available for the cases group and 203 for the controls. BDG and mannan levels were determined using the Fungitell® and Platelia™ Candida Ag tests, respectively. RESULTS BDG was detected early in sera from cases patients but was also present in several sera from controls. Increasing the cut-off from 80 pg/mL to 350 pg/mL and 800 pg/mL resulted in sensitivity/specificity ratios of 0.97/0.31, 0.65/0.74, 0.30/0.86, respectively. Detection of mannan was more specific but lacked sensitivity. No obvious correlation was found between BDG and colonisation, but a trend existed between high colonisation and high BDG. Candidaemia relapses were associated with a rise in BDG and mannan but, in contrast to the transient nature of mannan, BDG persisted up to 7 weeks after positive BCs. CONCLUSION A combination of mannan and BDG tests could be used to guide pre-emptive therapeutic decisions in ICU patients.
منابع مشابه
Epidemiology and outcome of Candida bloodstream infection in an intensive care unit in Hong Kong.
OBJECTIVE To study the epidemiology of Candida bloodstream infection in the Intensive Care Unit. DESIGN Retrospective study. SETTING A 22-bed, mixed medical and surgical Intensive Care Unit of a 1400-bed university teaching hospital in Hong Kong. PATIENTS All adult patients (>18 years) who had at least one blood culture positive for Candida. RESULTS During the 9 years of the study perio...
متن کاملPrior colonisation with Candida species fails to guide empirical therapy for candidaemia in critically ill adults.
OBJECTIVES Pre-emptive fluconazole (fcz) anti-fungal therapy is often based upon Candida colonisation of at least 2 non-contiguous non-sterile sites. The aim of this study was to evaluate the relationship between candidaemia and prior colonisation of non-sterile sites. METHODS A retrospective observational study was performed in the intensive care unit/high dependency unit (ICU/HDU) of a Univ...
متن کاملDNA Determination of Candida Species in Blood Cultures of Patients in Oncology Department and Intensive Care Unit in Zanjan Valiasr Hospital, 2017-2018
Background and purpose: Candidiasis is one of the most serious problems in adult and neonatal intensive care units. Molecular techniques play a key role in identifying invasive fungal infections and could be of great benefit beside other mycological diagnostic methods such as smear preparation and blood culture. The aim of this study was to detect candida species isolated from patients in onco...
متن کاملOne year prospective survey of Candida bloodstream infections in Scotland
A 12 month survey of candidaemia in Scotland, UK, in which every Scottish hospital laboratory submitted all blood isolates of yeasts for identification, strain typing and susceptibility testing, provided 300 isolates from 242 patients, generating incidence data of 4.8 cases per 100,000 population per year and 5.9 cases per 100,000 acute occupied bed days; 27.9 % of cases occurred in intensive c...
متن کاملCandida glabrata fungaemia in intensive care units.
Candidaemia is increasingly important in intensive care units (ICUs). Compared with Candida albicans fungaemia, the impact of C. glabrata fungaemia on ICU patients is not well-known. The aim of this study was to investigate the clinical features, the antifungal susceptibility and the treatment outcomes of C. glabrata fungaemia in ICU patients. The medical records of ICU patients with candidaemi...
متن کامل