评估血清β-D-葡聚糖检测在安全减少重症患者抗真菌治疗中的作用：一项回顾性研究。
Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study.
作者信息
Salhotra Ripenmeet, Biswal Debasish, Sarat Narayanan, Chawla Aayush, Mangla Sandeep, Gupta Pranjal, Subramaniam Rajeshwari
机构信息
Department of Anesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Faridabad, Haryana, India.
Department of Microbiology, Amrita institute of Medical Sciences and Research Centre, Faridabad, Haryana, India.
出版信息
Indian J Crit Care Med. 2025 May;29(5):413-417. doi: 10.5005/jp-journals-10071-24961. Epub 2025 May 8.
BACKGROUND AND AIMS
The role of (1→3)-β-D-glucan (BDG) testing in guiding antifungal therapy (AFT) in critically ill patients remains unclear. While BDG has a high negative predictive value (NPV), is it safe to withhold AFT in critically ill BDG-negative patients has not been well studied.
PATIENTS AND METHODS
This retrospective cohort study analyzed BDG-negative intensive care unit (ICU) patients (<60 pg/mL) at a tertiary care hospital from March 2024 to January 2025. The ICU survival was compared between those who received AFT and those who did not. Propensity score matching (PSM) adjusted for illness severity, and logistic regression identified independent predictors of survival.
RESULTS
Among 100 BDG-tested patients, 53 (53%) were BDG-negative. Of these, 22 (41.5%) received AFT, while 31 (58.5%) did not. Unadjusted ICU survival was lower in the AFT group (45.5%) vs no AFT (80.6%) ( = 0.008). Antifungal therapy recipients had higher sequential organ failure assessment (SOFA) scores (9.7 ± 3.46 vs 7.4 ± 3.15, = 0.014), indicating greater illness severity. Proven invasive candidiasis was rare (3.77%), with both cases due to Candida auris ( = 0.168). After PSM, survival differences were no longer significant ( = 0.246). Logistic regression confirmed AFT was not an independent predictor of survival [odds ratio (OR): 0.363, = 0.156].
CONCLUSIONS
Withholding AFT in BDG-negative critically ill patients did not impact ICU survival, supporting BDG's role in antifungal stewardship. However, its limitations in detecting Candida auris warrant further prospective studies.
HOW TO CITE THIS ARTICLE
Salhotra R, Biswal D, Sarat N, Chawla A, Mangla S, Gupta P, . Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study. Indian J Crit Care Med 2025;29(5):413-417.
背景与目的
（1→3）-β-D-葡聚糖（BDG）检测在指导重症患者抗真菌治疗（AFT）中的作用仍不明确。虽然BDG具有较高的阴性预测值（NPV），但在BDG阴性的重症患者中停用AFT是否安全尚未得到充分研究。
患者与方法
这项回顾性队列研究分析了2024年3月至2025年1月在一家三级医院的BDG阴性重症监护病房（ICU）患者（<60 pg/mL）。比较了接受AFT和未接受AFT患者的ICU生存率。倾向评分匹配（PSM）对疾病严重程度进行了调整，逻辑回归确定了生存的独立预测因素。
结果
在100例接受BDG检测的患者中，53例（53%）为BDG阴性。其中，22例（41.5%）接受了AFT，31例（58.5%）未接受。AFT组未调整的ICU生存率（45.5%）低于未接受AFT组（80.6%）（P = 0.008）。接受抗真菌治疗的患者序贯器官衰竭评估（SOFA）评分更高（9.7±3.46对7.4±3.15，P = 0.014），表明疾病严重程度更高。确诊的侵袭性念珠菌病罕见（3.77%），两例均由耳念珠菌引起（P = 0.168）。PSM后，生存差异不再显著（P = 0.246）。逻辑回归证实AFT不是生存的独立预测因素[比值比（OR）：0.363，P = 0.156]。
结论
在BDG阴性的重症患者中停用AFT不会影响ICU生存率，支持BDG在抗真菌管理中的作用。然而，其在检测耳念珠菌方面的局限性值得进一步进行前瞻性研究。
如何引用本文
Salhotra R, Biswal D, Sarat N, Chawla A, Mangla S, Gupta P, 。评估血清β-D-葡聚糖检测在安全减少重症患者抗真菌治疗中的作用：一项回顾性研究。《印度重症监护医学杂志》2025；29（5）：413 - 417。
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