Presence of Candida cell wall derived polysaccharides in the sera of intensive care unit patients: relation with candidaemia and Candida colonisation

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• 作者：Julien Poissy (84) (85) (86)
  Boualem Sendid (84) (85) (87)
  S茅bastien Damiens (84) (85)
  Ken Ichi Ishibashi (88)
  Nadine Fran莽ois (87)
  Marie Kauv (84) (86)
  Rapha毛l Favory (84) (86)
  Daniel Mathieu (84) (86)
  Daniel Poulain (84) (85) (87)
  
  84. Universit茅 Lille Nord de France ; 1 rue Lef猫vre ; 59000 ; Lille ; France
  85. INSERM U995-2 ; Facult茅 de M茅decine-P么le recherche ; Place de Verdun ; 59045 ; Lille ; France
  86. P么le de R茅animation ; CHRU Lille ; 2 avenue Oscar Lambret ; 59037 ; Lille Cedex ; France
  87. Laboratoire de Parasitologie Mycologie ; Institut de Microbiologie ; P么le de Biologie Pathologie G茅n茅tique ; rue Paul Nayrac ; CHRU Lille ; 59037 ; Lille Cedex ; France
  88. Laboratory for Immunopharmacology of Microbial Products ; School of Pharmacy ; University of Pharmacy and Life Science ; Hachioji ; Tokyo ; 192-0392 ; Japan
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：18
• 期：3
• 全文大小：801 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Prompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy. The poor sensitivity of blood cultures (BCs) has led to the development of fungal glycan tests as a diagnostic adjunct. We analysed the performance of tests for the detection of circulating 尾-D-1,3-glucan (BDG) and mannan in the intensive care unit (ICU) setting. Methods This retrospective, case鈥揷ontrol study included 43 ICU patients with candidaemia and 67 controls, hospitalised on the same ward and assessed weekly for yeast colonisation with simultaneous serum sampling; 340 sera taken before and after positive BCs were available for the cases group and 203 for the controls. BDG and mannan levels were determined using the Fungitell庐 and Platelia鈩?Candida Ag tests, respectively. Results BDG was detected early in sera from cases patients but was also present in several sera from controls. Increasing the cut-off from 80聽pg/mL to 350聽pg/mL and 800聽pg/mL resulted in sensitivity/specificity ratios of 0.97/0.31, 0.65/0.74, 0.30/0.86, respectively. Detection of mannan was more specific but lacked sensitivity. No obvious correlation was found between BDG and colonisation, but a trend existed between high colonisation and high BDG. Candidaemia relapses were associated with a rise in BDG and mannan but, in contrast to the transient nature of mannan, BDG persisted up to 7聽weeks after positive BCs. Conclusion A combination of mannan and BDG tests could be used to guide pre-emptive therapeutic decisions in ICU patients.