Role of serum (1,3)‐β‐d‐glucan assay in early diagnosis of invasive fungal infections in a neonatal intensive care unit

Shabaan, Abd Elazeez; Elbaz, Lobna Mahmoud; Elemshaty, Wafaa; Shouman, Basma

doi:10.1016/j.jpedp.2017.07.007

Cited by 10 publications

(13 citation statements)

References 27 publications

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“…This finding reiterates that described by Montagna et al 15 More notably, the sensitivity described in this study is considerably higher compared to other studies evaluating the assay in the neonatal population. [16][17][18] Possible reasons for the higher sensitivity may be the higher burden of disease in this population. Moreover, neonates have a poorly developed immune system which may result in higher fungal loads during infection, thereby resulting in higher BDG levels.…”

Section: Discussionmentioning

confidence: 98%

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

Fadana

Bosman²,

Nana

2019

Mycoses

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Summary Culture‐based diagnosis of candidaemia suffers poor sensitivity and prolonged turnaround time. The 1,3‐beta‐D‐glucan (BDG) assay is a non‐culture‐based broad fungal antigen with rapid turnaround time. To assess overall, species‐specific and population‐specific sensitivity of the BDG assay for candidaemia, to determine if the BDG assay is able to detect candidaemia prior to blood culture collection, and to evaluate the performance of the assay for the detection of Candida auris candidaemia. A retrospective review of all blood cultures (BC) with C albicans, C parapsilosis, C glabrata, C krusei and C auris was performed. A corresponding BDG result (Fungitell®) within 10 days of the BC was sought on the laboratory information system. Overall sensitivity of the assay was 79% (95% CI 73‐85; 173/218). Per species sensitivity was 81% (95% CI 72‐90; 66/81) for C albicans, 72% (61‐83; 60/83) for C parapsilosis, 90% (95% CI 79‐100; 27/30) for C glabrata, 71% (95% CI 43‐99; 10/14) C auris and 100% (10/10) for C krusei. No statistically significant difference in sensitivity between species was noted (P = .093). The assay demonstrated 92% (59/64) sensitivity in neonatal ICU (P = .047) compared to 94% (15/16) in surgery, 81% (59/73) in adult ICUs and 71% (15/21) in Oncology. BDG results were positive up to 10 days prior to blood culture collection with no significant difference in detection rate (P = .563). BDG results were positive up to 10 days prior to blood culture collection. BDG when collected a mean of 2.5 days (range 1‐10 days) prior to blood culture collection were positive.

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Section: Discussionmentioning

confidence: 98%

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

Fadana

Bosman²,

Nana

2019

Mycoses

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“…Sensitivity and specificity of the GKT® assay were 75% and 91%, respectively, in Liu's study, and 68% and 75%, respectively, in Zhao's. The reported threshold for the Dynamiker fungus® assay was 99 pg/ml, which seems in the same range than that of Fungitell®; its sensitivity and specificity were 64% and 95 %, respectively (40).…”

Section: Comparison With Previous Findingsmentioning

confidence: 89%

“…Three studies that evaluated BDG in neonates were excluded from this review because they didn't use the Fungitell® assay but a different commercial kit (i.e., GKT® and Dynamiker Fungus® assays) (38)(39)(40).…”

Section: Comparison With Previous Findingsmentioning

confidence: 99%

Diagnostic accuracy of serum (1,3)-beta-d-glucan for neonatal invasive candidiasis: systematic review and meta-analysis

Cohen

Ouziel

Matczak

et al. 2020

Clinical Microbiology and Infection

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Background: Neonatal invasive candidiasis (NIC) is a leading cause of infection-related morbidity and mortality in preterm neonates. Several studies have shown that (1,3)-Beta-D-Glucan (BDG) was accurate in detecting invasive fungal infection in adults, but studies in neonates are scarce. Objectives: To obtain summary estimates of the accuracy of BDG detection in serum for the diagnosis of NIC. Data sources: We searched Medline, Embase, Clinicaltrials.gov, and Google Scholar (inception to July 2019). We checked the reference lists of included studies, clinical guidelines, and review articles. Study eligibility criteria: We included studies that assessed the accuracy of BDG against a reference standard that defined groups of patients with ordinal levels of NIC probability (e.g., proven, probable, possible) and included fungal blood culture. Participants: Neonates suspected of having NIC. Interventions: BDG measurement in serum (Fungitell® assay). Methods: We assessed risk of bias and applicability using QUADAS-2. We used bivariate meta-analysis to produce summary estimates of diagnostic accuracy at prespecified positivity thresholds of 80 and 120 pg/ml. This study was registered with PROSPERO (CRD42018089545). Results: We included eight studies (465 participants). Of these, two were judged at low overall risk of bias. There was substantial variability across studies in the reference standards used. At a positivity threshold of 80 pg/ml, summary estimates of sensitivity and specificity of BDG were 89% (95% CI: 80%-94%) and 60% (53%-66%), respectively; summary sensitivity for detecting proven cases of NIC was 99% (93%-100%). At a positivity threshold of 120 pg/ml, summary estimates of sensitivity and specificity were 81% (71%-88%) and 80% (67%-88%), respectively. Conclusions: Because of high sensitivity, BDG seems promising to rule-out NIC. It might be too early to recommend its use because of the scarcity of reliable clinical data, heterogeneity in case definitions, and unstable accuracy estimates. Abbreviations BDG: (1,3)-Beta-D-Glucan CRP: C-reactive protein NIC: Neonatal invasive candidiasis

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“…Histopathological examination was the "gold standard" for the diagnosis of IFI, but as an invasive examination, it had been restricted in clinical practice [10]. Compared with the time-consuming and low detection rate of fungal culture [11], as a unique microbiological detection method for fungal infection [12], G test had the advantages of being specific, fast and accurate.…”

Section: Discussionmentioning

confidence: 99%

Significance of G Test [(1-3)-β-D-Glucan Assay] in the Diagnosis and Guidance of Clinical Medication of Invasive Fungal Infection

Xue¹

2019

AJIM

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Objective: G test [(1-3) -β-D-glucan assay] was a novel texting method for invasive fungal infection (IFI). The study evaluated the diagnostic value of G test for IFI by comparing G test with fungal culture method，and analyze the guiding significance of G test and fungal culture in clinical medication. Methods: 373 inpatients with suspected IFI in the first affiliated hospital of Jinan university from January to December 2017 were retrospectively analyzed. G test and fungal culture results were collected, and their positive rate, sensitivity, specificity, positive and negative predictive values were calculated. The value and rationality of G test for clinical diagnosis of IFI was evaluated by taking the relief and cure of infection symptoms of patients as clinical effective criteria. Results: Among 373 suspected IFI patients, the positive rate of G experiment was 39.95%, higher than that of fungus culture (28.95%, P<0.001). The positive rate of combined G test and fungal culture was 43.70%. To evaluate the consistency of G test with fungal culture method, κ value was 0.596 (P<0.001). When positive fungal culture was used as the criterion for the diagnosis of IFI, the sensitivity, specificity, positive predictive value and negative predictive value of G test for the diagnosis of IFI were 87.04%, 79.25%, 63.09% and 93.75%, respectively. All 373 patients with IFI received antifungal therapy, and the effective rate of the both methods positive group was 72.34%, higher than 42.86% in the only fungal culture positive group (P=0.033) and 30.48% in the both methods negative group (P<0.001). The effective rate of the only G test positive group was 58.18%, higher than that of the both methods negative group (30.48%, P<0.001). There was no significant difference in the therapeutic efficiency between the only G test positive group and the only fungal culture positive group (P=0.303). Conclusion: G test was an effective diagnostic method of IFI, and combined with fungal culture could improve its positive rate and have a higher guiding value for clinical medication.

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Role of serum (1,3)‐β‐d‐glucan assay in early diagnosis of invasive fungal infections in a neonatal intensive care unit

Cited by 10 publications

References 27 publications

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

Comparative sensitivity of 1,3 beta‐D‐glucan for common causes of candidaemia in South Africa

Diagnostic accuracy of serum (1,3)-beta-d-glucan for neonatal invasive candidiasis: systematic review and meta-analysis

Significance of G Test [(1-3)-β-D-Glucan Assay] in the Diagnosis and Guidance of Clinical Medication of Invasive Fungal Infection

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