Nuri Lee; Dohern Kim

doi:10.14192/kjhaicp.2019.24.1.26

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

Original Article

Korean Journal of Healthcare-Associated Infection Control and Prevention 2019; 24(1): 26-34.

Published online: 28 June 2019

DOI: https://doi.org/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

Nuri Lee¹, Dohern Kim²

¹Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.

²Department of Burn Surgery, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.

Correspondence to: Nuri Lee, Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, 12 Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 07247, Korea. Tel: 02-2639-5561, Fax: 02-2633-7571, nurilee822@hallym.or.kr

Received 27 March 2019 Revised 30 April 2019 Accepted 21 May 2019

Korean Society for Healthcare-Associated Infection Control and Prevention

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.

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

Figures and Tables

Fig. 1

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

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).

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.

Fig. 4

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

Table 1

Demographics of patients at the time of admission

Data are medians (IQRs, interquartile ranges) or frequencies.

^*P<0.05, ^**P<0.005.

Abbreviations: IFI, invasive fungal infections; IQR, interquartile ranges; TSBA, total body surface area.

Table 2

Interval likelihood ratio of (1,3)-β-D-glucan tests

^*Positive for invasive fungal infection proven or possible; ^†Negative for invasive fungal infection proven or possible.

Acknowledgements

This study was supported by Korean Society for Healthcare-associated Infection Control and Prevention.

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