Adults with candidemia and persistently negative (1,3)-β-D-glucan tests present with a better prognosis than comparative groups, according to data published in Clinical Infectious Diseases.
The clinical relevance and prognostic potential of persistently negative β-D-glucan tests was investigated in a retrospective study at a tertiary university hospital in Spain. Adults diagnosed with candidemia from 2012 to 2017 who had at least 2 serum β-D-glucan determinations throughout the episode of fungemia were included. The clinical and epidemiologic outcomes between patients with all negative test and those with any positive were compared.
Of the 148 patients in the study, 17.6% had persistently negative β-D-glucan results. Patients in this group were less likely to present Candida growth in all 3 sets of blood cultures (15.4% vs 45.1%; P = .005) and had less severe clinical presentations (median Pitt score, 0 vs 1 in patients with any positive β-D-glucan test; P = .039).
Adequate treatment was equally provided to both groups (96.2% in persistently negative group vs 93.4 in positive group; P = .599) but the negative group had a higher rate of microbiologic clearance in the first follow-up blood cultures than the positive group (92.3% vs 69.7%; P = .005). They also had fewer complications due to candidemia (7.7% vs 33.6%; P = .008), a lower 30-day mortality rate (3.8% vs 23.8%; P = .004), and a shorter in-hospital stay (34 days vs 51 days; P = .003). Persistently negative β-D-glucan tests were also associated with better prognoses (OR 0.12, 95% CI 0.03–0.49; P = .003) in multivariate analyses.
This study was limited by its retrospective nature, which may have affected the level of detail of the information retrieved, including actual blood volumes collected in each blood culture, which might impact positivity. This was also a single center trial, limiting the applicability of the results to populations with different prevalences of candidemia. Sample size was also relatively small and may have limited statistical power to better assess factors associated with negative β-D-glucan tests.
According to investigators, this is the first study designed to specifically evaluate the clinical utility or the underlying aspects associated with negative β-D-glucan tests in unselected candidemia episodes. They concluded that, “serum determination of [β-D-glucan] is a potential prognostic tool that appears to correlate with the systemic fungal burden in adults with proven candidemia.” Furthermore, using prediction rules combined with persistently negative β-D-glucan results and other relevant clinical and microbiological aspects could potentially be used in the future to individualize and possibly shorten the durations of antifungal therapy.
Agnelli C, Bouza E, Del Carmen Martínez-Jiménez M, et la. Clinical relevance and prognostic value of persistently negative (1,3)-β-D-glucan in adults with candidemia: A 5-year experience in a tertiary hospital. Clin Infect Dis. 2020;70:1925-1932.