The (1,3)-β-D-glucan use for invasive candidiasis diagnosis in non-neutropenic critically ill patients: a prospective cohort study.

Abstract

Introduction Invasive candidiasis (IC) is a widespread infection in intensive care. As culture-based diagnostic techniques take several days before positivity and leaks of sensitivity. (1,3)-β-D-glucan (BDG) was proposed as a mycological criterion for IC diagnosis in selected patients.

Aim: To determine the performance of BDG assay in the early diagnosis of IC in non-neutropenic critically ill patients Methods: We conducted a prospective evaluative study. All adults who were hospitalized in La Rabta Tertiary Hospital intensive care unit from January to June 2023 and at risk of IC were screened on a weekly basis. A true positive status corresponded to confirmed or highly probable IC and a positive BDG test (>80 pg/mL).

Results: A total of 123 BDG tests were performed on 85 patients with a median age of 58 years [41.5-67.5] and a median SOFA score=3 [2-5.5]. The median colonization index was 0.16 [0-0.33], and Candida albicans was the most common species isolated (71%). The median Candida score was 0.9 [0-2.9]. IC was retained in 30 cases. The median BDG level was 98 pg/mL [24-275]. Sixty-one patients had a positive BDG test, in whom only 21 had an IC. The performance of the BDG test in the diagnosis of IC was moderate (AUC/ROC=0.68 [0.575-0.788], p=0.003). The discriminatory power was better with the negative prediction (PNV=85.5%).

Conclusion: The major benefit of BDG test in intensive care seems to lie in its NPV allowing to roll out the invasive candidiasis diagnosis then withhold or interrupt antifungal therapy.