Combined Use of Serum (1,3)-β-D-glucan and Procalcitonin for the Early Differential Diagnosis Between Candidaemia and Bacteraemia in Intensive Care Units

Overview

Journal Crit Care

Specialty Critical Care

Date 2017 Jul 12

PMID 28693606

Citations 32

Authors

Daniele Roberto Giacobbe

Malgorzata Mikulska

Mario Tumbarello

Elisa Furfaro

Marzia Spadaro

Angela Raffaella Losito

Alessio Mesini

Gennaro De Pascale

Anna Marchese

Marco Bruzzone

Paolo Pelosi

Michele Mussap

Alexandre Molin

Massimo Antonelli

Brunella Posteraro

Maurizio Sanguinetti

Claudio Viscoli

Valerio Del Bono

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to assess the combined performance of serum (1,3)-β-D-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy.

Methods: From June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan's nomograms.

Results: One hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases.

Conclusions: The combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia.

Citing Articles

Prediction of candidemia with machine learning techniques: state of the art.

Giacobbe D, Marelli C, Mora S, Cappello A, Signori A, Vena A Future Microbiol. 2024; 19(10):931-940.

PMID: 39072500 PMC: 11290752. DOI: 10.2217/fmb-2023-0269.

The Diagnostic Accuracy of Procalcitonin and Its Combination with Other Biomarkers for Candidemia in Critically Ill Patients.

Kokkoris S, Angelopoulos E, Gkoufa A, Christodouli F, Ntaidou T, Theodorou E J Clin Med. 2024; 13(12).

PMID: 38930085 PMC: 11204834. DOI: 10.3390/jcm13123557.

Exploring European Consensus About the Remaining Treatment Challenges and Subsequent Opportunities to Improve the Management of Invasive Fungal Infection (IFI) in the Intensive Care Unit.

Hoenigl M, Enoch D, Wichmann D, Wyncoll D, Cortegiani A Mycopathologia. 2024; 189(3):41.

PMID: 38704761 PMC: 11070387. DOI: 10.1007/s11046-024-00852-3.

Retrospective Evaluation of Risk Factors for Invasive Infections in a Medical Intensive Care Unit.

Bilgin M, Talan L, Evren E, Altintas N Infect Dis Clin Microbiol. 2024; 4(1):62-71.

PMID: 38633547 PMC: 10986588. DOI: 10.36519/idcm.2022.56.

Early diagnosis of candidemia with explainable machine learning on automatically extracted laboratory and microbiological data: results of the AUTO-CAND project.

Giacobbe D, Marelli C, Mora S, Guastavino S, Russo C, Brucci G Ann Med. 2023; 55(2):2285454.

PMID: 38010342 PMC: 10836245. DOI: 10.1080/07853890.2023.2285454.

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