A prospective study of fungal biomarkers to improve management of invasive fungal diseases in a mixed specialty critical care unit

Alida Fe Talento*, Katie Dunne, Eimear Ann Joyce, Michael Palmer, Elizabeth Johnson, P. Lewis White, Jan Springer, Juergen Loeffler, Thomas Ryan, Daniel Collins, Thomas R. Rogers

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)

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 ≥ 7 days 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.

Original languageEnglish
Pages (from-to)119-127
Number of pages9
JournalJournal of Critical Care
Volume40
DOIs
Publication statusPublished - 1 Aug 2017

Bibliographical note

Publisher Copyright:
© 2017 Elsevier Inc.

Keywords

  • (1-3)-β-d-glucan
  • Critical care patients
  • Fungal biomarkers
  • Galactomannan
  • Invasive fungal disease

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