figshare
Browse

Combined use of serum (1,3)-β-d-glucan and procalcitonin for the early differential diagnosis between candidaemia and bacteraemia in intensive care units

Posted on 2017-07-10 - 05:00
Abstract Background This study aimed to assess the combined performance of serum (1,3)-β-d-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy. Methods From June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR–). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan’s nomograms. Results One hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases. Conclusions The combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia.

CITE THIS COLLECTION

DataCite
No result found
or
Select your citation style and then place your mouse over the citation text to select it.

SHARE

email

Usage metrics

Critical Care

AUTHORS (18)

Daniele Giacobbe
Malgorzata Mikulska
Mario Tumbarello
Elisa Furfaro
Marzia Spadaro
Angela Losito
Alessio Mesini
Gennaro De Pascale
Anna Marchese
Marco Bruzzone
Paolo Pelosi
Michele Mussap
Alexandre Molin
Massimo Antonelli
Brunella Posteraro
Maurizio Sanguinetti
Claudio Viscoli
Valerio Del Bono
need help?