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Novy E, Rivière J, Nguyen M, Arfeuille G, Louis G, Bouhemad B, Pottecher J, Hecketsweiler S, Germain A, Laithier FX, Losser MR, Debourgogne A, Bernard Y, Rousseau H, Baumann C, Luc A, Birckener J, Machouart MC, Guerci P. Combination of serum and peritoneal 1.3-beta-D-glucan can rule out intra-abdominal candidiasis in surgical critically ill patients: a multicenter prospective study. Crit Care 2023; 27:470. [PMID: 38037130 PMCID: PMC10691030 DOI: 10.1186/s13054-023-04761-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Intra-abdominal candidiasis (IAC) is difficult to predict in critically ill patients with intra-abdominal infection, leading to the overuse of antifungal treatments. Serum and peritoneal 1.3-beta-D-glucan (sBDG and pBDG) have been proposed to confirm or invalidate the diagnosis of IAC, but clinical studies have reported inconsistent results, notably because of heterogeneous populations with a low IAC prevalence. This study aimed to identify a high-risk IAC population and evaluate pBDG and sBDG in diagnosing IAC. METHODS This prospective multicenter noninterventional French study included consecutive critically ill patients undergoing abdominal surgery for abdominal sepsis. The primary objective was to establish the IAC prevalence. The secondary objective was to explore whether sBDG and pBDG could be used to diagnose IAC. Wako® beta-glucan test (WT, Fujifilm Wako Chemicals Europe, Neuss, Germany) was used for pBDG measurements. WT and Fungitell® beta-D-glucan assay (FA, Associate of Cape Cod, East Falmouth, USA) were used for sBDG measurements. RESULTS Between 1 January 2020 and 31 December 2022, 199 patients were included. Patients were predominantly male (63%), with a median age of 66 [54-72] years. The IAC prevalence was 44% (87/199). The main IAC type was secondary peritonitis. Septic shock occurred in 63% of cases. After multivariate analysis, a nosocomial origin was associated with more IAC cases (P = 0.0399). The median pBDG level was significantly elevated in IAC (448 [107.5-1578.0] pg/ml) compared to non-IAC patients (133 [16.0-831.0] pg/ml), P = 0.0021. For a pBDG threshold of 45 pg/ml, the negative predictive value in assessing IAC was 82.3%. The median sBDG level with WT (n = 42) at day 1 was higher in IAC (5 [3.0-9.0] pg/ml) than in non-IAC patients (3 [3.0-3.0] pg/ml), P = 0.012. Similarly, median sBDG level with FA (n = 140) at day 1 was higher in IAC (104 [38.0-211.0] pg/ml) than in non-IAC patients (50 [23.0-141.0] pg/ml), P = 0.009. Combining a peritonitis score < 3, sBDG < 3.3 pg/ml (WT) and pBDG < 45 pg/ml (WT) yielded a negative predictive value of 100%. CONCLUSION In critically ill patients with intra-abdominal infection requiring surgery, the IAC prevalence was 44%. Combining low sBDG and pBDG with a low peritonitis score effectively excluded IAC and could limit unnecessary antifungal agent exposure. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov (ID number 03997929, first registered on June 24, 2019).
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Affiliation(s)
- Emmanuel Novy
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France.
- SIMPA, UR7300, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France.
| | - Jérémie Rivière
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
- Service de Réanimation Polyvalente, CHR Metz-Thionville, 57000, Metz, France
| | - Maxime Nguyen
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU Dijon, 21000, Dijon, France
- INSERM UMR1231, Université de Bourgogne-Franche Comté, 21000, Dijon, France
| | - Gaëlle Arfeuille
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
| | - Guillaume Louis
- Service de Réanimation Polyvalente, CHR Metz-Thionville, 57000, Metz, France
| | - Bélaïd Bouhemad
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, CHU Dijon, 21000, Dijon, France
- INSERM UMR1231, Université de Bourgogne-Franche Comté, 21000, Dijon, France
| | - Julien Pottecher
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
- UR3072, FMTS, Faculté de Médecine, Maïeutique et Science de la sante, Université de Strasbourg, 67000, Strasbourg, France
| | - Stéphane Hecketsweiler
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67200, Strasbourg, France
| | - Adeline Germain
- Service de chirurgie digestive, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
- NGERE, U1256, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France
| | - François-Xavier Laithier
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Marie-Reine Losser
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
- DCAC, INSERM 1116, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France
| | - Anne Debourgogne
- SIMPA, UR7300, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France
- Service de mycologie et parasitologie, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Yohann Bernard
- Délégation À la recherche et à l'innovation, CHRU de Nancy, 54500, Vandœuvre-Lès-Nancy, France
| | - Hélène Rousseau
- Unité de Méthodologie, data management et statistiques, DRCI, CHRU de Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Cédric Baumann
- Unité de Méthodologie, data management et statistiques, DRCI, CHRU de Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Amandine Luc
- Unité de Méthodologie, data management et statistiques, DRCI, CHRU de Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Julien Birckener
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Marie-Claire Machouart
- SIMPA, UR7300, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France
- Service de mycologie et parasitologie, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
| | - Philippe Guerci
- Service d'Anesthésie-Réanimation et Médecine Péri-opératoire, CHRU Nancy - Hôpitaux de Brabois, 54500, Vandœuvre-Lès-Nancy, France
- DCAC, INSERM 1116, Université de Lorraine, 54500, Vandœuvre-Lès-Nancy, France
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Rahim A, Mutengesa E, Ware T, Wakerley D, Collier S, Davenport A. A case of Neurospora sitophila causing PD peritonitis. Perit Dial Int 2023; 43:417-420. [PMID: 37131324 DOI: 10.1177/08968608231167242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
We describe a rare case of fungal peritoneal dialysis (PD) peritonitis caused by the ascomycete fungus Neurospora sitophila (N. sitophila). The patient had little response to initial antibiotics and PD catheter removal was necessary for source control. The fungal biomarker β-d-glucan (BDG) was positive prior to N. sitophila being cultured and remained positive for 6 months after discharge. Use of BDG early in the assessment of PD peritonitis may reduce time to definitive therapy in fungal peritonitis.
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Affiliation(s)
- Anika Rahim
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | - Thuvaraka Ware
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | | | - Sophie Collier
- Department of Microbiology, Royal Free Hospital, London, UK
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Zakhem AE, Istambouli R, Jabbour JF, Hindy JR, Gharamti A, Kanj SS. Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients. Semin Respir Crit Care Med 2022; 43:46-59. [PMID: 35172358 DOI: 10.1055/s-0041-1741009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Invasive candidiasis (IC) has become a serious problem in the intensive care unit patients with an attributable mortality rate that can reach up to 51%. Multiple global surveillance studies have shown an increasing incidence of candidemia. Despite their limited sensitivity (21-71%), cultures remain the gold standard for the diagnosis of IC associated with candidemia. Many adjunct laboratory tests exist to support or rule out the diagnosis, each with its indications and limitations, including procalcitonin, 1,3-β-D-glucan, mannan and anti-mannan antibodies, and Candida albicans germ tube antibody. In addition, polymerase chain reaction-based methods could expedite species identification in positive blood cultures, helping in guiding early empirical antifungal therapy. The management of IC in critically ill patients can be classified into prophylactic, preemptive, empiric, and directed/targeted therapy of a documented infection. There is no consensus concerning the benefit of prophylactic therapy in critically ill patients. While early initiation of appropriate therapy in confirmed IC is an important determinant of survival, the selection of candidates and drug of choice for empirical systemic antifungal therapy is more controversial. The choice of antifungal agents is determined by many factors, including the host, the site of infection, the species of the isolated Candida, and its susceptibility profile. Echinocandins are considered initial first-line therapy agents. Due to the conflicting results of the various studies on the benefit of preemptive therapy for critically ill patients and the lack of robust evidence, the Infectious Diseases Society of America (IDSA) omitted this category from its updated guidelines and the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) do not recommend it.
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Affiliation(s)
- Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rachid Istambouli
- Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Jean-Francois Jabbour
- Department of Internal Medicine, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Joya-Rita Hindy
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Amal Gharamti
- Department of Internal Medicine, Yale School of Medicine, Waterbury Hospital, Waterbury, Connecticut
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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Lahmer T, Peçanha-Pietrobom PM, Schmid RM, Colombo AL. Invasive fungal infections in acute and chronic liver impairment: A systematic review. Mycoses 2021; 65:140-151. [PMID: 34837414 DOI: 10.1111/myc.13403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022]
Abstract
Patients with acute and chronic liver impairment are susceptible to invasive fungal infections such as candidemia and invasive pulmonary aspergillosis as a result of cirrhosis-associated immune dysfunction, humoral immunodeficiency, cell-mediated dysfunction and systemic inflammation. Besides classical risk factors for invasive fungal infection, acute-on-chronic liver failure, corticosteroid use, gastrointestinal bleeding, and prophylactic use of antibiotics are all additional conditions which are related to the potential development of fungal infections. Therefore, high-risk patients should be carefully followed by microbiological surveillance including cultures but also by imaging and fungal biomarkers for providing early diagnosis. Echinocandins are still the mainstay and first line antifungal therapy in cases of invasive candidiasis. Due to concerns of liver toxicity and in cases of renal impairment liposomal amphotericin B is a suitable alternative to voriconazole in patients with invasive pulmonary aspergillosis. Although, data of isavucoanzole and posaconazole use in those patients are also promising more specific studies in the subgroup of patients with liver impairment are needed. Especially, due to the late diagnosis and multiple organ dysfunction usually present in patients with liver impairment morbidity and mortality rates remain high. Based on the broad spectrum of diverse reports with varying content and quality and in some cases lack of evidence we performed a systematic review on this topic.
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Affiliation(s)
- Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen, Universität München, Munich, Germany
| | - Paula M Peçanha-Pietrobom
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen, Universität München, Munich, Germany
| | - Arnaldo Lopes Colombo
- Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2018. Critical care. Experimental and clinical studies. Minerva Anestesiol 2020; 85:95-105. [PMID: 30632731 DOI: 10.23736/s0375-9393.18.13524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini, ASST - Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Division of Anesthesiology and Resuscitation, Department of Emergency and Organ Transplantation (DETO), Aldo Moro University of Bari, Policlinic Hospital, Bari, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, University Policlinic A. Gemelli IRCCS Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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