Impact of the Beta-Glucan Test on Management of Intensive Care Unit Patients at Risk for Invasive Candidiasis

Details

Serval ID
serval:BIB_4BEDA4FB01DB
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Impact of the Beta-Glucan Test on Management of Intensive Care Unit Patients at Risk for Invasive Candidiasis
Journal
Journal of Clinical Microbiology
Author(s)
Kritikos Antonios, Poissy Julien, Croxatto Antony, Bochud Pierre-Yves, Pagani Jean-Luc, Lamoth Frederic
ISSN
0095-1137
1098-660X
ISSN-L
0095-1137
Publication state
Published
Issued date
01/04/2020
Peer-reviewed
Oui
Editor
Hanson Kimberly E.
Volume
58
Number
6
Pages
e01996-19
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The 1,3-beta-d-glucan (BDG) test is used for the diagnosis of invasive candidiasis (IC) in intensive care units (ICUs). However, its utility for patient management is unclear. This study assessed the impact of BDG test results on therapeutic decisions. This was a single-center observational study conducted in an ICU over two 6-month periods. All BDG test requests for the diagnosis of IC were analyzed. Before the second period, the ICU physicians received a pocket card instruction (algorithm) for targeted BDG testing in high-risk patients. The performance of the BDG test for IC diagnosis was assessed, as well as its impact on antifungal (AF) prescription. Overall, 72 patients had ≥1 BDG test, and 14 (19%) patients had an IC diagnosis. The BDG test results influenced therapeutic decisions in 41 (57%) cases. The impact of the BDG test was positive in 30 (73%) of them, as follows: AF abstention/interruption following a negative BDG result (n = 27), and AF initiation/continuation triggered by a positive BDG test result and subsequently confirmed IC (n = 3). In 10 (24%) cases, a positive BDG test result resulted in AF initiation/continuation with no further evidence of IC. A negative BDG result and AF abstention with subsequent IC diagnosis were observed in one case. The positive predictive value (PPV) of BDG was improved if testing was restricted to the algorithm's indications (80% versus 36%, respectively). However, adherence to the algorithm was low (26%), and no benefit of the intervention was observed. The BDG result had an impact on therapeutic decisions in more than half of the cases, which consisted mainly of safe AF interruption/abstention. Targeted BDG testing in high-risk patients improves PPV but is difficult to achieve in ICU.
Keywords
Microbiology (medical)
Pubmed
Web of science
Create date
04/04/2020 16:24
Last modification date
18/11/2020 7:24
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