Clinical Relevance and Prognostic Value of Persistently Negative (1,3)-β-D-Glucan in Adults With Candidemia: A 5-year Experience in a Tertiary Hospital

• Published in: Clinical infectious diseases Vol. 70; no. 9; pp. 1925 - 1932
• Main Authors: Agnelli, Caroline, Bouza, Emilio, del Carmen Martínez-Jiménez, María, Navarro, Raquel, Valerio, Maricela, Machado, Marina, Guinea, Jesús, Sánchez-Carrillo, Carlos, Alonso, Roberto, Muñoz, Patricia
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 15-04-2020
• Subjects: Adult; beta-Glucans; Candidemia - diagnosis; Candidemia - drug therapy; Candidemia - epidemiology; Glucans; Humans; Prognosis; Retrospective Studies; Sensitivity and Specificity; Tertiary Care Centers; mortality; antifungal stewardship; candidemia; prognosis; biomarkers
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciz555

Abstract
Background
The clinical relevance and the potential prognostic role of persistently negative (1,3)-β-D-glucan (BDG) in adults with proven candidemia is unknown.
Methods
This retrospective study included all adults diagnosed with candidemia our tertiary university hospital from 2012–2017 who had at least 2 serum BDG determinations throughout the episode of fungemia (Fungitell Assay; positive cut-off ≥80pg/mL). Epidemiology and clinical outcomes were compared between patients with all negative versus any positive BDG tests. Poor clinical outcomes included complications due to candidemia or 30-day all-cause mortality.
Results
Overall, 26/148 (17.6%) candidemic adults had persistently negative BDG tests. These patients were less likely to present Candida growth in all 3 sets of blood cultures (15.4% vs 45.1%; P = .005) and had less severe clinical presentations (median Pitt score, 0 [interquartile range {IQR} 0–1] vs 1 [IQR 0–2] in patients with any positive BDG test; P = .039). Although adequate treatment was equally provided to both groups (96.2% in persistently negative group vs 93.4 in positive group; P = .599), the persistently negative group had a higher rate of microbiological clearance in the first follow-up blood cultures (92.3% vs 69.7% in positive group; P = .005), fewer complications due to candidemia (7.7% vs 33.6% in positive group; P = .008), a lower 30-day mortality rate (3.8% vs 23.8% in positive group; P = .004), and a shorter in-hospital stay (34 days [IQR 18–55] vs 51 days [IQR 35–91] in positive group; P = .003). In the multivariate analysis, persistently negative BDG tests were independently associated with better prognoses (odds ratio 0.12, 95% confidence interval 0.03–0.49; P = .003).
Conclusions
Candidemic patients with persistently negative BDG tests present a better prognosis than the comparative group, probably due to a lower systemic fungal burden. In this context, the appropriate use of persistently negative BDG results could be an aid to individualize therapeutic management in the near future.
Persistently negative (1,3)-β-D-glucan in adults with proven candidemia is associated with a lower systemic fungal load, less severe clinical presentations, fewer complications due to candidemia, lower 30-day mortality rates, and shorter total lengths of in-hospital stays.