ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2018 December;84(12):1369-76

DOI: 10.23736/S0375-9393.18.12619-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Determination of 1,3-β-D-glucan in the peritoneal fluid for the diagnosis of intra-abdominal candidiasis in critically ill patients: a pilot study

Emmanuel NOVY ^{1, 2} ✉, François-Xavier LAITHIER ¹, Marie-Claire MACHOUART ³, Eliane ALBUISSON ⁴, Philippe GUERCI ^{1, 2}, Marie-Reine LOSSER ^{1, 2}

¹ Department of Anesthesiology and Critical Care Medicine, Regional University Hospital of Nancy, Nancy, France; ² Faculty of Medicine, University of Lorraine, Nancy, France; ³ Department of Parasitology and Mycology, Regional University Hospital of Nancy, Nancy, France; ⁴ Unit of Methodology, Data Management and Statistics (UMDS), Regional University Hospital of Nancy, Nancy, France

BACKGROUND: Decision to start an anti-fungal therapy in intra-abdominal candidiasis (IAC) is complex. Yeast culture, considered the gold standard, suffers from a delayed response time and exposes the patient to delayed introduction of anti-fungal therapy. We sought to evaluate the performance and feasibility of measuring 1,3-β-D-glucan (1,3-BDG) in the peritoneal fluid (PF) for the diagnosis of IAC.
METHODS: We analyzed retrospectively all PF obtained during abdominal surgery for critically ill adult patients presenting intra-abdominal infections. For each PF sample, direct examination, bacterial and fungal culture, fungal PCR and 1,3-BDG measurements were performed. The diagnostic performance of each technique and the Peritonitis score were calculated considering the positive yeast culture as the reference. The levels of 1,3-BDG were compared between IAC and non-IAC patients.
RESULTS: During an 8-month period in 2016, 33 PF samples were recovered. Median (interquartile range) SAPS 2 and SOFA scores were 44 (9-94) and 9 (4-15), respectively. There were seven cases of IAC, 14 of bacterial peritonitis and 12 of undocumented peritonitis. All IAC cases were secondary peritonitis, with a 1,3-BDG level of 1461 (325-5000) versus 224 (68-1357) pg/mL in the non-IAC group (P=0.03). When the 1,3-BDG level was ≤310 pg/mL, its negative predictive value was 100%.
CONCLUSIONS: In secondary peritonitis, a peritoneal measurement of 1,3-BDG ≤310 pg/mL could rule out IAC.

KEY WORDS: Candidiasis - Peritonitis - Diagnostics - Beta-1,3-D-glucan - Critical illness