laminaran and Candidemia

Patients with C. difficile infection (CDI) experience intestinal microflora changes that can promote the overgrowth and subsequent translocation of gut resident pathogens into the blood. Consistently, CDI due to PCR-ribotype 027 strain, severe or relapsing CDI, and treatment with high-dosage vancomycin are independent risk factors for candidemia.. We review the role played by the gut microbiota during CDI and its treatment, as well as the clinical profile of CDI patients who are at risk of developing candidemia. Also, we discuss the management of these patients by focusing on pre-emptive strategies aimed at reducing the risk of candidemia, and on innovative anti-C. difficile therapies that may mitigate CDI-related effects such as the altered gut microbiota composition and prolonged intestinal mucosa damage. Expert commentary: A closer clinical and diagnostic monitoring of patients with CDI should help to limit the CDI-associated long-term consequences, including Candida infections, which worsen the outcome of hospitalized patients.

Topics: Anti-Bacterial Agents; Antifungal Agents; beta-Glucans; Candidemia; Clostridioides difficile; Enterocolitis, Pseudomembranous; Humans; Intestinal Mucosa; Microbiota; Nystatin; Risk Factors

Although the serum 1,3-β-D-glucan test has been used as an early diagnostic marker of candidemia, there are few studies regarding the association of serum 1,3-β-D-glucan levels with candidemia in severe burn patients. The purpose of this study was to elucidate the clinical significance of 1,3-β-D-glucan for the diagnosis of candidemia in severe burn patients. Data from 51 severe burn patients whose serum levels of 1,3-β-D-glucan had been measured for the suspicion of invasive fungal infection were analyzed retrospectively. The primary outcome in this study was the detection of candidemia. The levels of 1,3-β-D-glucan (pg/ml) in candidemia and noncandidemia groups ranged from 41.1 to 600.0 with a median of 90.6 and from 5.0 to 41.3 with a median of 6.8, respectively. A significant difference in the levels of 1,3-β-D-glucan was observed between the two groups. The optimal cutoff value was 40 pg/ml, with a sensitivity of 100% and a specificity of 95%, whereas the conventional cutoff value (11 pg/ml) resulted in a sensitivity of 100% and a specificity of 68%. The 1,3-β-D-glucan test was found to be useful for detecting candidemia in severe burn patients, and the cutoff value might be set to 40 pg/ml to detect it more accurately.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; beta-Glucans; Biomarkers; Burns; Candidemia; Child; Female; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity

Prompt diagnosis of candidaemia and invasive candidosis is crucial to the early initiation of antifungal therapy. The poor sensitivity of blood cultures (BCs) has led to the development of fungal glycan tests as a diagnostic adjunct. We analysed the performance of tests for the detection of circulating β-D-1,3-glucan (BDG) and mannan in the intensive care unit (ICU) setting.. This retrospective, case-control study included 43 ICU patients with candidaemia and 67 controls, hospitalised on the same ward and assessed weekly for yeast colonisation with simultaneous serum sampling; 340 sera taken before and after positive BCs were available for the cases group and 203 for the controls. BDG and mannan levels were determined using the Fungitell® and Platelia™ Candida Ag tests, respectively.. BDG was detected early in sera from cases patients but was also present in several sera from controls. Increasing the cut-off from 80 pg/mL to 350 pg/mL and 800 pg/mL resulted in sensitivity/specificity ratios of 0.97/0.31, 0.65/0.74, 0.30/0.86, respectively. Detection of mannan was more specific but lacked sensitivity. No obvious correlation was found between BDG and colonisation, but a trend existed between high colonisation and high BDG. Candidaemia relapses were associated with a rise in BDG and mannan but, in contrast to the transient nature of mannan, BDG persisted up to 7 weeks after positive BCs.. A combination of mannan and BDG tests could be used to guide pre-emptive therapeutic decisions in ICU patients.

Topics: Aged; Antibodies; beta-Glucans; Biomarkers; Candidemia; Case-Control Studies; Cell Wall; Early Diagnosis; Female; Fungal Polysaccharides; Humans; Intensive Care Units; Male; Mannans; Middle Aged; Recurrence; Retrospective Studies; Sensitivity and Specificity

Microbiological diagnosis of nosocomial candidemia is negatively affected by suboptimal culture yield. Alternative methods are not fully reliable as an aid in candidemia diagnosis. Recently, the detection of (1,3)-β-D-glucan (BG) has been shown to be very promising in this setting. We carried out a prospective study on the clinical usefulness of BG detection in early diagnosis of candidemia. BG detection was performed in patients with fever unresponsive to antibacterial agents and risk factors for candidemia. BG detection was done with the Fungitell test. A total of 152 patients were included in the study; 53 were proven to have candidemia, while in 52 patients candidemia was excluded on microbiological and clinical bases. The remaining 47 patients were considered to have possible candidemia. In summary, 41 of 53 candidemia patients (77.3%), 9 of 52 patients without candidemia (17.3%), and 38 of 47 patients with possible candidemia (80.8%) were positive in the BG assay. With these results, the sensitivity and the specificity of the assay were 77% and 83%, respectively. BG levels of >160 pg/ml were highly predictive of candidemia. In 36 of 41 patients with candidemia and positive BG testing, the BG assay was performed within 48 h from when the first Candida-positive blood sample for culture was drawn, thus allowing a possible earlier start of antifungal therapy. Based on these results, the BG assay may be used as an aid in the diagnosis of nosocomial candidemia. The timing of assay performance is critical for collecting clinically useful information. However, the test results should be associated with clinical data.

Topics: Antigens, Fungal; beta-Glucans; Candidemia; Clinical Laboratory Techniques; Cross Infection; Early Diagnosis; Humans; Immunoassay; Prospective Studies; Sensitivity and Specificity