Background: Candidemia is one of the major problems in neonatal and pediatric care unit settings. Microbiological diagnosis of nosocomial candidemia is negatively affected by suboptimal culture yield.1,3-β-D-glucan (BDG) detection is an emerging tool and very promising in this setting. Although bacteremia has been reported to be related to false positive results in the BDG test, the evidence for this interaction is limited. Aim: The aim of this study was to assess the value of serum BDG as a rapid method in the diagnosis of neonatal candidemia, to assess its value in monitoring response to antifungal therapy and to investigate its association with bacteremia. Patients and Methods: By using the Fungitell (Associates of Cape Cod Inc., East Falmouth, MA, USA) assay kit, the serum BDG level was examined in 15 candidemic, 15 bacteremic and 15 healthy controls. The patients of candidemia group treated with intravenous antifungal drugs and the BDG levels before and after therapy was measured. Results: This study found that (86.7%) of proven candidemia were positive for BDG test. The median serum BDG level was significantly higher in candidemia group (415 pg/ml) than in both bacteremia group (88 pg/ml) and control group (64 pg/ml) (p < 0.001). However, there was no significant difference in median BDG levels between bacteremia group and control group (p>0.05). The result of BDG in all bacteremic cases was negative except for one case (6.7%) that show elevated BDG level above the cut-off value and in this case, the causative agent of bacteremia was Pseudomonas aeruginosa. The median BDG level in candidemia group at the start of antifungal therapy (415 pg/ml) was significantly higher than that after therapy (97 pg/ml) (P = 0.002). Conclusion: BDG assay is useful as an aid in diagnosis of candidemia and is of value in evaluating the efficacy of antifungal therapy in neonates. False positivity of the BDG with bacteremia is a rare condition. |
