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Serum 1,3‐beta‐d‐glucan for antifungal treatment stratification at the intensive care unit and the influence of surgery
Authors:Jürgen Prattes  Martin Hoenigl  Jasmin Rabensteiner  Reinhard B. Raggam  Florian Prueller  Ines Zollner‐Schwetz  Thomas Valentin  Katharina Hönigl  Sonja Fruhwald  Robert Krause
Affiliation:1. Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, , Graz, Austria;2. Division of Pulmonology, Medical University of Graz, , Graz, Austria;3. Division of Infectious Diseases, University of California San Diego, , San Diego, CA, USA;4. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, , Graz, Austria;5. Division of Anesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, , Graz, Austria
Abstract:
The purpose of this study was to evaluate a preemptive approach with serum 1,3‐beta‐d ‐glucan (BDG) as a marker for treatment stratification of systemic antifungal (AF) therapy in patients with clinical suspected invasive fungal infections (IFI) at intensive care units (ICU), and the impact of surgical procedures. A total of 66 ICU patients with clinical suspected IFI were included in this retrospective analysis. Serum BDG testing was performed prior to initiation of AF treatment and in addition to routine diagnostic measures. Based on the BDG results the initial clinical decision whether or not to start systemic AF therapy was re‐evaluated. Impact of surgical procedures on clinical utility of serum BDG was evaluated in a sub‐group of 25 patients who had undergone surgical procedures prior to BDG evaluation. BDG test results led to discontinuation of AF therapy in 13 patients, and initiation of AF therapy in seven patients. In 46 patients the clinical decision was confirmed by BDG. The majority of suspected, probable and proven IFI cases (10/13, 77%) was predicted by the test. BDG testing turned out positive in 9/25 (36%) of patients that had undergone recent surgery and levels correlated with clinical findings. Serum BDG evaluation seems to be a promising tool to guide AF therapy in ICU patients even after recent surgical procedures.
Keywords:1,3‐Beta‐d‐glucan  intensive care unit  serum  surgery  antifungal therapy
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