Prognostic Value of Serum (1→3)-β-D-Glucan Levels in Patients with Candidemia Stratified by Compliance with Candida Bundle: A Multicenter Retrospective Cohort Study (2016-2023).

IF 2.9 3区生物学 Q2 MYCOLOGY

Mycopathologia Pub Date : 2025-09-22 DOI:10.1007/s11046-025-00999-7

Hidemasa Akazawa, Shinnosuke Fukushima, Toshie Higuchi, Tomoko Miyoshi, Yasuhiro Nakano, Koji Iio, Yukinobu Akamatsu, Yuto Haruki, Yoshitaka Iwamoto, Shuichi Tanaka, Shun Fujisato, Soichiro Ako, Hideharu Hagiya

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引用次数: 0

Abstract

Background: Candidemia is a severe systemic infection with a high mortality risk. While β-D-glucan (BDG) serves as a diagnostic biomarker, its prognostic value in candidemia, particularly in association with Candida bundle compliance, remains unclear.

Methods: In this retrospective multicenter cohort study, we evaluated 96 patients with candidemia across nine Japanese hospitals between 2016 and 2023. Candida bundle compliance was assessed using five key components: central venous catheter removal within 24 h of diagnosis, appropriate initial antifungal therapy, ophthalmologic examination, follow-up blood cultures until clearance, and antifungal therapy for at least two weeks post-clearance. Analyses stratified patients by serum BDG status (positive/negative) and compliance with the Candida bundle (high: 4-5 points; low: 0-3 points). The primary outcome was 30-day mortality, and the secondary outcome was defined as endophthalmitis incidence.

Results: Of 96 eligible patients with candidemia, 70 (72.9%) were BDG-positive and 26 (27.1%) were BDG-negative. The overall 30-day mortality was 17.7%. Among BDG-positive patients, 15 (21.4%) died, while 2 (7.7%) died in BDG-negative cohorts (p = 0.09). Serum BDG positivity demonstrated a statistically significant association with decreased survival rates in the low bundle adherence group (p = 0.02), whereas this correlation was not observed among patients in the high-compliance cohort (p = 0.66). Endophthalmitis occurred in 25.0% of patients, without significant correlation to serum BDG status. C. albicans was associated with a significantly higher incidence of endophthalmitis compared with non-albicans species (45.7% vs. 8.9%).

Conclusions: Serum BDG positivity potentially correlates with worse survival in candidemia, particularly in patients with low bundle compliance. This emphasizes the importance of adherence to standardized Candida management protocols for optimizing patient outcomes.

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念珠菌束依从性分层患者血清（1→3）-β- d -葡聚糖水平的预后价值：一项多中心回顾性队列研究（2016-2023）

背景：念珠菌是一种严重的全身性感染，死亡率高。虽然β- d -葡聚糖（BDG）作为一种诊断性生物标志物，但其在念珠菌病中的预后价值，特别是与念珠菌束依从性的关系尚不清楚。方法：在这项回顾性多中心队列研究中，我们评估了2016年至2023年间日本9家医院的96例念珠菌患者。念珠菌束依从性通过五个关键组成部分进行评估：在诊断后24小时内取出中心静脉导管，适当的初始抗真菌治疗，眼科检查，随访血培养直到清除，以及清除后至少两周的抗真菌治疗。根据血清BDG状态（阳性/阴性）和念珠菌束依从性对患者进行分层分析（高：4-5分，低：0-3分）。主要终点为30天死亡率，次要终点为眼内炎发生率。结果：96例符合条件的念珠菌病患者中，bdg阳性70例（72.9%），bdg阴性26例（27.1%）。总体30天死亡率为17.7%。bdg阳性组15例（21.4%）死亡，bdg阴性组2例（7.7%）死亡（p = 0.09）。血清BDG阳性与低束依从组的生存率降低有统计学意义（p = 0.02），而在高束依从组的患者中没有观察到这种相关性（p = 0.66）。25.0%的患者发生眼内炎，与血清BDG状态无显著相关性。与非白色念珠菌相比，白色念珠菌与眼内炎的发生率明显更高（45.7%比8.9%）。结论：血清BDG阳性可能与念珠菌病患者较差的生存率相关，特别是在低束依从性患者中。这强调了遵守标准化念珠菌管理方案对优化患者预后的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mycopathologia 生物-真菌学

CiteScore

6.80

自引率

3.60%

发文量

审稿时长

3 months

期刊介绍： Mycopathologia is an official journal of the International Union of Microbiological Societies (IUMS). Mycopathologia was founded in 1938 with the mission to ‘diffuse the understanding of fungal diseases in man and animals among mycologists’. Many of the milestones discoveries in the field of medical mycology have been communicated through the pages of this journal. Mycopathologia covers a diverse, interdisciplinary range of topics that is unique in breadth and depth. The journal publishes peer-reviewed, original articles highlighting important developments concerning medically important fungi and fungal diseases. The journal highlights important developments in fungal systematics and taxonomy, laboratory diagnosis of fungal infections, antifungal drugs, clinical presentation and treatment, and epidemiology of fungal diseases globally. Timely opinion articles, mini-reviews, and other communications are usually invited at the discretion of the editorial board. Unique case reports highlighting unprecedented progress in the diagnosis and treatment of fungal infections, are published in every issue of the journal. MycopathologiaIMAGE is another regular feature for a brief clinical report of potential interest to a mixed audience of physicians and laboratory scientists. MycopathologiaGENOME is designed for the rapid publication of new genomes of human and animal pathogenic fungi using a checklist-based, standardized format.