Oldberg Karl, Stenmark Jakob, Hammarström Helena
Department of Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Lund, Sweden.
Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Mycoses. 2025 May;68(5):e70067. doi: 10.1111/myc.70067.
Serum 1,3-β-d-glucan (BDG) tests are frequently used for diagnosing invasive candidiasis. However, BDG tests remain negative in many patients with candidemia, and factors influencing the probability for positive test results are poorly understood.
To study clinical and microbiological factors predictive of a positive BDG test, as well as the association of a positive BDG test with mortality in patients with candidemia.
In a retrospective cohort of patients with candidemia, BDG was analysed by the Glucatell assay and the Wako Beta-Glucan Test. Predisposing conditions, focus of infection and other variables were retrieved from medical charts and laboratory databases. Their association with a positive BDG test, and the association between positive BDG and death was tested in univariate analysis and multivariable logistic regression.
We included 134 patients with candidemia. Positive BDG and a non-abdominal deep-seated focus of infection (e.g., hematogenously disseminated infection and deep mediastinal/pleural candidiasis) were positively correlated in univariate and multivariable analyses [Wako adjusted odds ratio 9.11 (95% CI 1.66-172, p = 0.039), Glucatell adjOR 9.14 (95% CI 1.66-172, p = 0.039)]. Having a positive BDG test increased the risk for 90 days mortality after controlling for potential confounders, mainly age, septic shock, and ICU admission [Wako adjOR 4.73 (95% CI 1.71-14.7, p = 0.0043), Glucatell adjOR 3.59 (95% CI 1.33-10.6, p = 0.015)].
In patients with candidemia, a positive BDG test is more common in the presence of a concomitant non-abdominal deep-seated infection. Patients with a positive BDG test have a higher 90-day mortality.
血清1,3-β-d-葡聚糖（BDG）检测常用于诊断侵袭性念珠菌病。然而，许多念珠菌血症患者的BDG检测仍为阴性，且对影响检测结果呈阳性概率的因素了解甚少。
研究预测BDG检测呈阳性的临床和微生物学因素，以及BDG检测呈阳性与念珠菌血症患者死亡率的关联。
在一组念珠菌血症患者的回顾性队列研究中，采用Glucatell检测法和和光β-葡聚糖检测法分析BDG。从病历和实验室数据库中获取诱发因素、感染灶及其他变量。在单因素分析和多变量逻辑回归中检验它们与BDG检测呈阳性的关联，以及BDG检测呈阳性与死亡之间的关联。
我们纳入了134例念珠菌血症患者。在单因素和多变量分析中，BDG检测呈阳性与非腹部深部感染灶（如血行播散性感染和深部纵隔/胸膜念珠菌病）呈正相关[和光调整优势比9.11（95%CI 1.66 - 172，p = 0.039），Glucatell调整优势比9.14（95%CI 1.66 - 172，p = 0.039）]。在控制了潜在混杂因素（主要是年龄、感染性休克和入住重症监护病房）后，BDG检测呈阳性增加了90天死亡率的风险[和光调整优势比4.73（95%CI 1.71 - 14.7，p = 0.0043），Glucatell调整优势比3.59（95%CI 1.33 - 10.6，p = 0.015）]。
在念珠菌血症患者中，存在合并的非腹部深部感染时，BDG检测呈阳性更为常见。BDG检测呈阳性的患者90天死亡率更高。
