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KMID : 1141420190240010026
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Korean Journal of Healthcare-associated Infection Control Prevention
2019 Volume.24 No. 1 p.26 ~ p.34
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The Effectiveness of (1,3)-β-D-Glucan Assay for Diagnosis of Invasive Fungal Infections in Patients with Burn Injury
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Lee Nu-Ri
Kim Do-Hern
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Abstract
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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.
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KEYWORD
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Beta-1,3-D-glucan, Burns, Candidemia, Invasive fungal infections
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