(1,3)-β-D-葡聚糖能够预测念珠菌血症患者治疗失败，而不仅仅是死亡率。

(1,3)-β-D-glucan is able to predict therapeutic failure of patients with candidemia and not only mortality.

机构信息

Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.

Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

出版信息

Mycoses. 2021 Mar;64(3):264-271. doi: 10.1111/myc.13224. Epub 2020 Dec 19.

DOI:10.1111/myc.13224

PMID:33274533

Abstract

BACKGROUND

Candidemia is a major cause of bloodstream infection in tertiary hospitals worldwide and fungal biomarkers may provide early diagnosis.

OBJECTIVES

To evaluate the performance of (1-3)-β-D-glucan (BDG) in the diagnosis of candidemia and its ability to predict therapeutic failure.

PATIENTS AND METHODS

This was a prospective, multi-centre study conducted in 3 Brazilian hospitals. Clinical outcome was evaluated along 2 weeks of treatment, and therapeutic failure was defined as the occurrence of persistent candidemia, Candida deep-seated infection or death. Baseline BDG detection was performed with the Fungitell assay (Associates of Cape Cod, Falmouth-USA).

RESULTS

We enrolled a total of 71 patients with candidemia and a control group with 110 healthy volunteers. The sensitivity and specificity of BDG for diagnosing candidemia were as follows: 71.8% (95% confidence interval [95% CI] 59.7% - 81.5%) and 98.2% (95% CI 92.9% - 99.7%), respectively. The only predictor of therapeutic failure was a higher BDG value at diagnosis of candidemia; a value > 226 pg/mL predicted failure with sensitivity and specificity of 75% and 78%, respectively.

CONCLUSIONS

A high baseline serum BDG value was associated with therapeutic failure.

摘要

背景

念珠菌血症是全球三级医院血流感染的主要原因，真菌生物标志物可能提供早期诊断。

目的

评估（1-3）-β-D-葡聚糖（BDG）在念珠菌血症诊断中的表现及其预测治疗失败的能力。

患者和方法

这是一项在巴西 3 家医院进行的前瞻性、多中心研究。临床结局在治疗的 2 周内进行评估，治疗失败定义为持续念珠菌血症、深部念珠菌感染或死亡的发生。使用 Fungitell 检测法（美国科德角协会，法尔茅斯）进行基线 BDG 检测。

结果

我们共纳入了 71 例念珠菌血症患者和 110 例健康志愿者作为对照组。BDG 诊断念珠菌血症的敏感性和特异性分别为 71.8%（95%置信区间 [95%CI] 59.7% - 81.5%）和 98.2%（95% CI 92.9% - 99.7%）。念珠菌血症诊断时 BDG 值较高是治疗失败的唯一预测因素；BDG 值>226pg/mL 时，其敏感性和特异性分别为 75%和 78%。