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.

Autor:	Agnelli C; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Department of Medicine, Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil., Bouza E; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CB06/06/0058), Spain.; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain., Del Carmen Martínez-Jiménez M; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Navarro R; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Valerio M; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain., Machado M; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain., Guinea J; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CB06/06/0058), Spain.; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain., Sánchez-Carrillo C; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón., Alonso R; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain., Muñoz P; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón.; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CB06/06/0058), Spain.; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2020 Apr 15; Vol. 70 (9), pp. 1925-1932.
DOI:	10.1093/cid/ciz555
Abstrakt:	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. (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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