Alida Fe Talento1, Katie Dunne2, Eimear Ann Joyce3, Michael Palmer4, Elizabeth Johnson4, P Lewis White5, Jan Springer6, Juergen Loeffler6, Thomas Ryan7, Daniel Collins7, Thomas R Rogers8. 1. Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Microbiology Department, St. James's Hospital, Dublin, Ireland. Electronic address: talenta@tcd.ie. 2. Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland. 3. Radiology Department, St. James's Hospital, Dublin, Ireland. 4. Public Health England Mycology Reference Laboratory, Bristol, England, United Kingdom. 5. Public Health Wales Microbiology Cardiff, University Hospital of Wales Cardiff, Wales, United Kingdom. 6. University of Wuerzburg Medical Centre, Department for Internal Medicine II, Wuerzburg, Germany. 7. Anaesthetics Department, St. James's Hospital, Dublin, Ireland. 8. Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Microbiology Department, St. James's Hospital, Dublin, Ireland.
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.
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.
Authors: Marina Machado; Esther Chamorro de Vega; María Del Carmen Martínez-Jiménez; Carmen Guadalupe Rodríguez-González; Antonio Vena; Raquel Navarro; María Isabel Zamora-Cintas; Caroline Agnelli; María Olmedo; Alicia Galar; Jesús Guinea; Ana Fernández-Cruz; Roberto Alonso; Emilio Bouza; Patricia Muñoz; Maricela Valerio Journal: J Fungi (Basel) Date: 2021-01-17
Authors: D Hare; C Coates; M Kelly; E Cottrell; E Connolly; E G Muldoon; B O' Connell; T R Rogers; A F Talento Journal: Infect Prev Pract Date: 2020-02-19