Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Clin Infect Dis. 2020 Apr 15;70(9):1925-1932. doi: 10.1093/cid/ciz555.
The clinical relevance and the potential prognostic role of persistently negative (1,3)-β-D-glucan (BDG) in adults with proven candidemia is unknown.
This retrospective study included all adults diagnosed with candidemia our tertiary university hospital from 2012-2017 who had at least 2 serum BDG determinations throughout the episode of fungemia (Fungitell Assay; positive cut-off ≥80pg/mL). Epidemiology and clinical outcomes were compared between patients with all negative versus any positive BDG tests. Poor clinical outcomes included complications due to candidemia or 30-day all-cause mortality.
Overall, 26/148 (17.6%) candidemic adults had persistently negative BDG tests. These patients were less likely to present Candida growth in all 3 sets of blood cultures (15.4% vs 45.1%; P = .005) and had less severe clinical presentations (median Pitt score, 0 [interquartile range {IQR} 0-1] vs 1 [IQR 0-2] in patients with any positive BDG test; P = .039). Although adequate treatment was equally provided to both groups (96.2% in persistently negative group vs 93.4 in positive group; P = .599), the persistently negative group had a higher rate of microbiological clearance in the first follow-up blood cultures (92.3% vs 69.7% in positive group; P = .005), fewer complications due to candidemia (7.7% vs 33.6% in positive group; P = .008), a lower 30-day mortality rate (3.8% vs 23.8% in positive group; P = .004), and a shorter in-hospital stay (34 days [IQR 18-55] vs 51 days [IQR 35-91] in positive group; P = .003). In the multivariate analysis, persistently negative BDG tests were independently associated with better prognoses (odds ratio 0.12, 95% confidence interval 0.03-0.49; P = .003).
Candidemic patients with persistently negative BDG tests present a better prognosis than the comparative group, probably due to a lower systemic fungal burden. In this context, the appropriate use of persistently negative BDG results could be an aid to individualize therapeutic management in the near future.
在确诊为念珠菌血症的成年人中，持续阴性（1,3）-β-D-葡聚糖（BDG）的临床相关性和潜在预后作用尚不清楚。
本回顾性研究纳入了 2012 年至 2017 年期间我院确诊为念珠菌血症的所有成年患者，这些患者在整个真菌感染期间至少有 2 次血清 BDG 检测（Fungitell 检测；阳性截断值≥80pg/ml）。比较所有 BDG 检测均为阴性与任何 BDG 检测阳性患者的流行病学和临床结局。不良临床结局包括念珠菌血症相关并发症或 30 天全因死亡率。
总体而言，148 例念珠菌血症成人中有 26 例（17.6%）持续 BDG 检测阴性。这些患者血液培养中连续 3 次均未见念珠菌生长的比例更低（15.4% vs 45.1%；P=.005），临床表现也更轻微（中位 Pitt 评分，0[四分位距{IQR}0-1] vs 1[IQR 0-2]，BDG 检测阳性患者；P=.039）。虽然两组均给予了同等的充分治疗（持续阴性组 96.2% vs 阳性组 93.4%；P=.599），但持续阴性组在首次随访血培养中微生物清除率更高（92.3% vs 阳性组 69.7%；P=.005），念珠菌血症相关并发症更少（7.7% vs 阳性组 33.6%；P=.008），30 天死亡率更低（3.8% vs 阳性组 23.8%；P=.004），住院时间更短（34 天[IQR 18-55] vs 阳性组 51 天[IQR 35-91]；P=.003）。多变量分析显示，持续阴性 BDG 检测与更好的预后独立相关（比值比 0.12，95%置信区间 0.03-0.49；P=.003）。
持续 BDG 检测阴性的念珠菌血症患者预后优于对照组，可能是因为其全身性真菌负荷较低。在这种情况下，持续阴性 BDG 结果的适当应用可能有助于在不久的将来实现个体化治疗管理。
