Combined use of serum (1,3)-β-d-glucan and procalcitonin for the early differential diagnosis between candidaemia and bacteraemia in intensive care units

Daniele Roberto Giacobbe, Malgorzata Mikulska, Mario Tumbarello, Elisa Furfaro, Marzia Spadaro, Angela Raffaella Losito, Alessio Mesini, Gennaro De Pascale, Anna Marchese, Marco Bruzzone, Paolo Pelosi, Michele Mussap, Alexandre Molin, Massimo Antonelli, Brunella Posteraro, Maurizio Sanguinetti, Claudio Viscoli, Valerio Del Bono, on behalf of ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)

This study aimed to assess the combined performance of serum (1,3)-β-D-glucan (BDG) and procalcitonin (PCT) for the differential diagnosis between candidaemia and bacteraemia in three intensive care units (ICUs) in two large teaching hospitals in Italy. From June 2014 to December 2015, all adult patients admitted to the ICU who had a culture-proven candidaemia or bacteraemia, as well as BDG and PCT measured closely to the time of the index culture, were included in the study. The diagnostic performance of BDG and PCT, used either separately or in combination, was assessed by calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-). Changes from pre-test probabilities to post-test probabilities of candidaemia and bacteraemia were inferred from Fagan's nomograms. One hundred and sixty-six patients were included, 73 with candidaemia (44%) and 93 with bacteraemia (56%). When both markers indicated candidaemia (BDG ≥80 pg/ml and PCT <2 ng/ml) they showed higher PPV (96%) compared to 79% and 66% for BDG or PCT alone, respectively. When both markers indicated bacteraemia (BDG <80 pg/ml and PCT ≥2 ng/ml), their NPV for candidaemia was similar to that of BDG used alone (95% vs. 93%). Discordant BDG and PCT results (i.e. one indicating candidaemia and the other bacteraemia) only slightly altered the pre-test probabilities of the two diseases. The combined use of PCT and BDG could be helpful in the diagnostic workflow for critically ill patients with suspected candidaemia.