• Alida Fe Talento, Katie Dunne, Eimear Ann Joyce, Michael Palmer, Elizabeth Johnson, P Lewis White, Jan Springer, Juergen Loeffler, Thomas Ryan, Daniel Collins, and Thomas R Rogers.
• Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland; Microbiology Department, St. James's Hospital, Dublin, Ireland. Electronic address: talenta@tcd.ie.
• J Crit Care. 2017 Aug 1; 40: 119-127.

PurposeThe diagnosis of invasive fungal diseases (IFD) in critical care patients (CrCP) is difficult. The study investigated the performance of a set of biomarkers for diagnosis of IFD in a mixed specialty critical care unit (CrCU).MethodsA prospective observational study in patients receiving critical care for ≥7days was performed. Serum samples were tested for the presence of: (1-3) - β-d-glucan (BDG), galactomannan (GM), and Aspergillus fumigatus DNA. GM antigen detection was also performed on bronchoalveolar lavage (BAL) samples. The patients were classified using published definitions for IFD and a diagnostic algorithm for invasive pulmonary aspergillosis. Performance parameters of the assays were determined.ResultsIn patients with proven and probable IFD, the sensitivity, specificity, PPV and NPV of a single positive BDG were 63%, 83%, 65% and 83% respectively. Specificity increased to 86% with 2 consecutive positive results. The mean BDG value of patients with proven and probable IFD was significantly higher compared to those with fungal colonization and no IFD (p value<0.0001).ConclusionNew diagnostic criteria which incorporate these biomarkers, in particular BDG, and host factors unique to critical care patients should enhance diagnosis of IFD and positively impact antifungal stewardship programs.Copyright © 2017 Elsevier Inc. All rights reserved.

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