Gtest and GMtest combined with sputum fungal culture for the early diagnosis of invasive fungal infection in intensive care unit patients

Abstract:

ObjectiveTo evaluate the detection value of serum (1,3)βD glucan (Gtest) and galactomannan(GMtest) combined with sputum fungal culture in the early diagnosis of invasive fungal infection(IFI) in intensive care unit(ICU) patients. MethodsInpatients with high risk factors for IFI in the ICU of the Affiliated Hospital of Xuzhou Medical University between January 2015 and December 2016 were chosen, they were divided into 3 groups according to the diagnostic criteria of IFI: IFI group(including confirmed and clinically diagnosed cases), suspected IFI group, and nonIFI group. The results of serum Gtest, GMtest, and sputum fungal culture in three groups of patients were analyzed, early diagnostic value in IFI with combined three tests was evaluated. ResultsA total of 264 ICU patients were investigated, IFI group, suspected IFI group, and nonIFI group were 56, 43, and 165 cases respectively. Among 56 cases of confirmed IFI, 46, 39, and 34 were positive for Gtest, GMtest, and fungal culture respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of combined three detection were 98.2%, 82.4%, 65.5%, and 99.3% respectively, positive likelihood ratio, negative likelihood ratio, and Youden index were 5.58, 0.02, and 0.98 respectively. The sensitivity and negative predictive values of combined three detection were both higher than those of single Gtest, GMtest, and sputum fungal culture(all P<0.05); but specificity and positive predictive value of combined three detection were not significantly different from single Gtest, GMtest, and sputum fungal culture(all P>0.05). ConclusionThe combination of Gtest, GMtests, and sputum fungal culture can improve the sensitivity of early diagnosis of IFI in ICU patients, and guide the clinicians in the early treatment of IFI.