Ullah Nadir, Muccio Marco, Magnasco Laura, Sepulcri Chiara, Giacobbe Daniele Roberto, Vena Antonio, Bassetti Matteo, Mikulska Malgorzata
Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy.
UO Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
J Fungi (Basel). 2025 Feb 15;11(2):149. doi: 10.3390/jof11020149.
1, 3-ß-D-Glucan (BDG) is an antigen present in the cell wall of many pathogenic fungi and is used as a marker for the early diagnosis of candidemia and discontinuation of empirical treatment. Changes in the epidemiology of species might have a negative impact on the performance of serum BDG. The aim of this study was to analyze the performance of BDG in candidemia diagnosis focusing on species-specific differences in BDG sensitivity and BDG levels.
The PRISMA system was used for the systematic search. The following databases were searched for articles published from January 2010 to November 2023: PubMed, Science Direct, and Scopus.
A total of 21 studies that met the inclusion criteria were included, reporting data from 1633 patients with candidemia; 11 reported both sensitivity and specificity, 15 reported species-specific sensitivity, and nine reported species-specific BDG levels. The pooled sensitivity of BDG in all studies was 0.73 (95% confidence interval (CI), 0.66-0.80), while the pooled sensitivity and specificity in 11 studies were 0.81 (95% CI 0.73-0.89) and 0.80 (95% CI 0.74-0.87). BDG pooled sensitivity (all assays) and BDG levels (for assays with cutoff of 80 pg/mL) were the highest in (currently ) and the lowest in : 0.76 and 417 pg/mL for , 0.73 and 345 pg/mL for , 0.74 and 356 pg/mL for (currently ), 0.70 and 324 pg/mL for , 0.63 and 95 pg/mL for 0.51 and 62 pg/mL for and 0.44 and 79 pg/mL for other species. These differences were statistically significant for BDG sensitivity and levels of , , , and compared to , , and other species.
The sensitivity of BDG in candidemia diagnosis depends on the species, with the lowest being for and . This might have a clinical impact in centers where these species are prevalent.
1,3-β-D-葡聚糖（BDG）是许多致病真菌细胞壁中的一种抗原，用作念珠菌血症早期诊断和经验性治疗停药的标志物。念珠菌菌种流行病学的变化可能会对血清BDG检测结果产生负面影响。本研究的目的是分析BDG在念珠菌血症诊断中的性能，重点关注BDG敏感性和BDG水平的菌种特异性差异。
采用PRISMA系统进行系统检索。检索了以下数据库中2010年1月至2023年11月发表的文章：PubMed、Science Direct和Scopus。
共纳入21项符合纳入标准的研究，报告了1633例念珠菌血症患者的数据；11项研究报告了敏感性和特异性，15项研究报告了菌种特异性敏感性，9项研究报告了菌种特异性BDG水平。所有研究中BDG的合并敏感性为0.73（95%置信区间（CI），0.66 - 0.80），而11项研究中的合并敏感性和特异性分别为0.81（95%CI 0.73 - 0.89）和0.80（95%CI 0.74 - 0.87）。BDG合并敏感性（所有检测方法）和BDG水平（截断值为80 pg/mL的检测方法）在[具体菌种1]中最高，在[具体菌种2]中最低：[具体菌种1]的分别为0.76和417 pg/mL，[具体菌种3]的为0.73和345 pg/mL，[具体菌种4]（当前）的为0.74和356 pg/mL，[具体菌种5]的为0.70和324 pg/mL，[具体菌种6]的为0.63和95 pg/mL，[具体菌种7]的为0.51和62 pg/mL，其他[具体菌种8]的为0.44和79 pg/mL。与[对比菌种1]、[对比菌种2]和其他[对比菌种3]相比，[具体菌种1]、[具体菌种3]、[具体菌种4]和[具体菌种5]的BDG敏感性和水平差异具有统计学意义。
BDG在念珠菌血症诊断中的敏感性取决于念珠菌菌种，[具体菌种2]和[具体菌种7]的敏感性最低。在这些菌种流行的中心，这可能会产生临床影响。
