Invasive fungal infections and (1,3)-β-d-glucan serum concentrations in long-term intensive care patients
Received 7 January 2008; received in revised form 12 October 2008; accepted 20 October 2008. published online 21 January 2009.
Summary
Objective
Invasive fungal infections are associated with high morbidity and increased mortality. This study was performed to assess the epidemiology of fungal infections and to determine (1,3)-β-d-glucan serum concentrations in patients admitted to intensive care units (ICUs).
Patients and methods
Overall 197 patients were admitted to nine medical and surgical intensive care units (ICUs) at a 2200-bed university hospital during a 3-month period. Retrospectively, the patients were split into three groups: group A comprised 24 patients with proven invasive fungal infections admitted for a median of 40 days. Group B comprised 58 patients who were admitted to the ICU for 30 days but without fungal infection. One hundred and fifteen post-operative patients served as controls (group C). The levels of (1,3)-β-d-glucan were monitored in all patients twice weekly during their ICU admittance.
Results
Average (1,3)-β-d-glucan concentrations were significantly higher in the patients with fungal infections compared to group B and group C (median 44 vs. 22 and 12.9pg/ml, respectively; p<0.001). For a serum (1,3)-β-D-glucan level of 40 pg/ml, the sensitivity, the specificity, the positive predictive value, the negative predictive value, the area under the curve of the receiver operating characteristics (AUC ROC) curve, the likelihood ratio (LR)+ and LR− were 52.2, 75.9, 46.2, 80, 0.7, 2.16, and 0.63, respectively, on day 7. Patients in group A had bacterial infections significantly more often than patients in group B (p=0.003). The hospitalization before ICU admittance for group A was significantly longer than for groups B and C (median 19 (group A) vs. 6 (group B) vs. 10 (group C) days; p<0.05).
Conclusions
Longer hospitalization and multiple bacterial infections were found to be the main risk factors for invasive fungal infections. Long-term ICU patients have elevated (1,3)-β-d-glucan levels, not only due to invasive fungal infections, but also due to the serious underlying diseases and conditions, inter-current complications, and intensive care measures. Yet, persistently high serum levels of (1,3)-β-d-glucan in ICU patients may be indicative of invasive fungal infections and warrant additional diagnostic efforts.
Corresponding Editor: Andy I.M. Hoepelman, Utrecht, The Netherlands
aDepartment of Medicine I, Division of Infectious Diseases, Medical University of Vienna - Allgemeines Krankenhaus, Waehringer Guertel 18–20, 1090 Vienna, Austria
bDepartment of Otorhinology, Medical University of Vienna - Allgemeines Krankenhaus, Vienna, Austria
cDepartment of Medicine III, Division of Nephrology, Medical University of Vienna - Allgemeines Krankenhaus, Vienna, Austria
dDepartment of Anaesthesia and General Intensive Care Medicine, Division of Cardiothoracic Anaesthesia, Medical University of Vienna – Allgemeines Krankenhaus, Vienna, Austria
eDepartment of Trauma Surgery, Medical University of Vienna - Allgemeines Krankenhaus, Vienna, Austria
ABSTRACT