Serum (1,3)-beta-D-glucan is an inefficient marker of breakthrough candidemia
Serum (1,3)-beta-D-glucan is an inefficient marker of breakthrough candidemia
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DOI：
10.1093/mmy/myu066
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发表时间：
2014-11-01
期刊：
影响因子：
2.9
通讯作者：
Yoneyama, Akiko
中科院分区：
文献类型：
--
作者：
Abe, Masahiro;Kimura, Muneyoshi;Yoneyama, Akiko
本研究的目的是评估血清（1，3）-β-D-葡聚糖（BDG）对早期检测突破性念珠菌血症的有用性。我们回顾了2008年1月至2013年3月期间念珠菌血症患者的病历。采用和子比浊法测定血清BDG。在研究期间，共确定了147例念珠菌血症，31例患者符合突破性念珠菌血症的标准。对25例突破性念珠菌血症患者和67例非突破性念珠菌血症患者的血清BDG水平进行了测定。几乎所有发生突破性念珠菌血症的患者都患有血液系统恶性肿瘤。非C菌引起的念珠菌血症较多。突破组中白色念珠菌的检出率高于非突破组（92.0% vs. 61.8%，p = 0.005）。突破性发作的中位BDG值显著低于非突破性发作（18.5 pg/ml vs. 90.4 pg/ml，p = 0.01）。此外，临界值以下的BDG值在突破性念珠菌血症患者中显著高于非突破性念珠菌血症患者（44% vs. 19%，p = 0.03）。总之，单独的BDG不足以检测突破性念珠菌血症，即使BDG值低于临界值，接受抗真菌药物治疗的患者也可能发生念珠菌血症。
The aim of this study was to evaluate the usefulness of serum (1,3)-beta-D-glucan (BDG) for earlier detection of breakthrough candidemia. We reviewed the medical records of patients with candidemia from January 2008 to March 2013. Serum BDG was measured by Wako turbidimetric assay. During the study period, a total of 147 cases of candidemia were identified, and 31 patients met the criteria for breakthrough candidemia. Serum BDG levels were measured in 25 patients with breakthrough candidemia and 67 patients with nonbreakthrough candidemia. Almost all of the patients with breakthrough candidemia had hematological malignancies. More candidemia were caused by non-C. albicans Candida in the breakthrough group than in the nonbreakthrough group (92.0% vs. 61.8%, p = .005). The median BDG value was significantly lower in breakthrough episodes than in non-breakthrough episodes (18.5 pg/ml vs. 90.4 pg/ml, p = .01). Moreover, BDG values under the cutoff was significantly higher in patients with breakthrough candidemia than in those with nonbreakthrough candidemia (44% vs. 19%, p = .03). In summary, BDG alone was insufficient to detect breakthrough candidemia, and candidemia could occur in patients being treated with antifungal agents, even when the BDG value was under the cutoff value.