Korean J healthc assoc Infect Control Prev.  2019 Jun;24(1):26-34. 10.14192/kjhaicp.2019.24.1.26.

The Effectiveness of (1,3)-β-D-Glucan Assay for Diagnosis of Invasive Fungal Infections in Patients with Burn Injury

• Lee N
• Kim D

• KMID: 2451555
• DOI: http://doi.org/10.14192/kjhaicp.2019.24.1.26

Abstract

BACKGROUND
Fungal infections are emerging as a major cause of healthcare-associated infection, and invasive fungal infections (IFI) are associated with high mortality in burn patients. The (1,3)-β-D-glucan (BG) assay has been increasingly used for the diagnosis of IFI, but its effectiveness remains uncertain. As such, we evaluated the BG test in patients with severe burn injuries.
METHODS
From July to December 2018, a total of 86 patients with major burn injuries were prospectively tested using a Fungitell assay (Cape Code, East Falmouth, MA). BG levels were measured within the first week of intensive care unit admission and compared with clinical symptoms of patients and results of a fungal culture.
RESULTS
A total of 11 patients were identified as proven or possible IFI. Thirty seven patients (43.0%) were positive, 5 (5.8%) were intermediate, and 44 (51.2%) were negative based on a 60-80 pg/mL cutoff. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.8%, 56.0%, 24.3%, and 95.5%, respectively. A receiver operating characteristic (ROC) analysis showed an area under the curve of 0.725, an optimal cut-off of 124.2 pg/mL, a sensitivity of 81.8%, and a specificity of 74.7%.
CONCLUSION
The BG test in burn patients showed moderate accuracy and high negative predictive values but very low positive predictive values. We conclude that the BG test is not useful as a screening tool for IFI, but it is recommended as a follow-up in ruling out the discontinuation of treatment.

Keyword

Beta-1,3-D-glucan; Burns; Candidemia; Invasive fungal infections

MeSH Terms

Burns*
Candidemia
Diagnosis*
Follow-Up Studies
Humans
Intensive Care Units
Mass Screening
Mortality
Prospective Studies
ROC Curve
Sensitivity and Specificity

Figure

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  Fig. 1 Distribution of (1,3)-β-D-glucan levels divided by an interval of 100 pg/mL.

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  Fig. 2 Comparison of (1,3)-β-D-glucan levels in patients with and without proven or possible invasive fungal infections (IFI). Patients with proven or possible invasive fungal infection (IFI) (N=11) showed statistically significantly higher (1,3)-β-D-glucan levels (157.2 pg/mL, 95% CI: 124.7–185.2 pg/mL) compared to patients without proven or possible IFI (51.3 pg/mL, 95% CI: 10.0–125.0 pg/mL, N=75).

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  Fig. 3 Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of (1,3)-β-D-glucan for (A) invasive fungal infection (IFI) proven (B) IFI proven or possible.

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  Fig. 4 Receiver operator characteristic (ROC) curve of (1,3)-β-D-glucan cutoff values to define invasive fungal infection (IFI).

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