1,3-β-d-Glucan contamination of common antimicrobials: Table 1.

Liss, Blasius; Cornely, Oliver A.; Hoffmann, Dennis; Dimitriou, Vassiliki; Wisplinghoff, Hilmar

doi:10.1093/jac/dkv419

Cited by 44 publications

(34 citation statements)

References 11 publications

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“…Particularly, we excluded many patients with concurrent use of antibiotics. The concern that if concurrent use of antibiotics possibly confounded BDG assay remains a conflicting issue [33–40]. It needs a large-scale study to validate this issue.…”

Section: Discussionmentioning

confidence: 99%

Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study

Chou

Hsiao

et al. 2017

BMC Infect Dis

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BackgroundWhile Candida pneumonia is life-threatening, biomarker measurements to early detect suspected Candida pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-D-glucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected Candida pneumonia in immunocompromised and critically ill patients.MethodsThis prospective, observational study enrolled immunocompromised, critically ill, and ventilated patients with suspected fungal pneumonia in mixed intensive care units from November 2010 to October 2011. Patients with D-glucan confounding factors or other fungal infection were excluded. Endotracheal aspirate, bronchoalveolar lavage fluid and serum were collected from each patient to perform a fungal smear, culture, and D-glucan assay.ResultsAfter screening 166 patients, 31 patients completed the study and were categorized into non-Candida pneumonia/non-candidemia (n = 18), suspected Candida pneumonia (n = 9), and non-Candida pneumonia/candidemia groups (n = 4). D-glucan levels in endotracheal aspirate or bronchoalveolar lavage were highest in suspected Candida pneumonia, while the serum D-glucan level was highest in non-Candida pneumonia/candidemia. In all patients, the D-glucan value in endotracheal aspirate was positively correlated with that in bronchoalveolar lavage fluid. For the detection of suspected Candida pneumonia, the predictive performance (sensitivity/specificity/D-glucan cutoff [pg/ml]) of D-glucan in endotracheal aspirate and bronchoalveolar lavage fluid was 67%/82%/120 and 89%/86%/130, respectively, accounting for areas under the receiver operating characteristic curve of 0.833 and 0.939 (both P < 0.05), respectively. Measuring serum D-glucan was of no diagnostic value (area under curve =0.510, P = 0.931) for the detection of suspected Candida pneumonia in the absence of concurrent candidemia.ConclusionsD-glucan levels in both endotracheal aspirate and bronchoalveolar lavage, but not in serum, provide good diagnostic values to detect suspected Candida pneumonia and to serve as potential biomarkers for early detection in this patient population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2364-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study

Chou

Hsiao

et al. 2017

BMC Infect Dis

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“…After exposure to glucan‐containing surgical gauze or sponges, BDG levels are expected to return to normal within 3–4 days. In addition, therapy with multiple antimicrobials has been associated with false‐positive BDG, including cephalosporins and β‐lactam/β‐lactamase inhibitor combinations . Therefore, clinical interpretation is challenging in the setting of interfering antimicrobials and no standard recommendation exists.…”

Section: Evidence For Specific Novel Biomarkersmentioning

confidence: 99%

“…Therefore, clinical interpretation is challenging in the setting of interfering antimicrobials and no standard recommendation exists. Proposed solutions to this clinical interpretation problem include elimination of BDG contamination from the antimicrobial manufacturing process or disclosure of the amount of BDG in the antimicrobial package insert …”

Section: Evidence For Specific Novel Biomarkersmentioning

confidence: 99%

Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

et al. 2018

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As antimicrobial stewardship increasingly receives worldwide attention for improving patient care by optimizing antimicrobial therapy, programs are evaluating new tools that may augment antimicrobial stewardship activities. Biomarkers are objective, accurate, and reproducible measures that provide information about medical conditions. A systematic literature search using PubMed/MEDLINE databases was performed to evaluate the use of novel biomarkers as additions to the antimicrobial stewardship armamentarium. Procalcitonin may help clinicians discriminate between bacterial and viral infections, help with antimicrobial discontinuation decisions, and predict mortality. β‐d‐glucan, Candida albicans germ tube antibody, and galactomannan are useful in suspected fungal infections and may reduce inappropriate antifungal use. Adrenomedullin and soluble triggering receptor on myeloid cells‐1 may be useful for mortality prediction and the determination of a need for empiric antibacterials. Although studies evaluating these biomarkers are promising, these biomarkers are not without limitations and should be used in combination with clinical signs, symptoms, or other biomarkers. For successful implementation of biomarker use, stewardship programs should consider the populations most likely to benefit, without using them indiscriminately in all patients. Antimicrobial stewardship programs should facilitate education of clinicians through institutional guidelines to ensure the appropriate use and interpretation of these biomarkers.

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“…Therefore, it is rather a panfungal diagnostic method not specific for Candida species . Furthermore, false‐positivity of the β‐1,3‐ d ‐glucan assay remains a clinical challenge . Candida mannan/anti‐mannan testing do not facilitate discrimination between different Candida species .…”

Section: Introductionmentioning

confidence: 99%

Candida‐reactive T cells for the diagnosis of invasive Candida infection of the lumbar vertebral spine

Koehler

Cornely

Wisplinghoff

et al. 2017

Mycoses

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SummaryInvasive Candida infection is the fourth most common bloodstream infection. Blood cultures are the current gold standard diagnostic method, however, false negatives remain a clinical challenge. We developed a new technique measuring Candidareactive T cells as diagnostic read-out for invasive Candida infection. In a pilot study, we followed the treatment course of a patient with an invasive Candida infection of the lumbar vertebral spine. We present the case of a 56-year-old patient with HIVassociated Burkitt lymphoma who developed septic shock during chemotherapyinduced neutropenia. For the first time, we provide flow cytometry-based diagnostics with Candida-reactive T cells for invasive candidiasis with comprehensive MRI imaging. The Candida-reactive T cell assay has potential to complement current diagnostic assays for invasive Candida infection and thus to support targeted treatment. K E Y W O R D SCandida spondylodiscitis, candidaemia, CD154, flow cytometry, invasive candidiasis, osteomyelitis

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1,3-β-d-Glucan contamination of common antimicrobials: Table 1.

Abstract: A majority of the available antimicrobial substances contained BDG, potentially limiting the utility of BDG testing in the context of prior exposure to these drugs. As the cumulative effects of repeated BDG exposure are unknown, efforts to reduce contamination should be considered.

Cited by 44 publications

References 11 publications

Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study

Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study

Evaluation of the Use of Novel Biomarkers to Augment Antimicrobial Stewardship Program Activities

Candida‐reactive T cells for the diagnosis of invasive Candida infection of the lumbar vertebral spine

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