β-(1→3)-D-glucan- and mannan-guided early termination of antifungal therapy in ICU patients: a randomized controlled study

Erb T, Mihai S, Strauss R, Herbst L, Castellanos I, Diesch K, Cipa F, Bihlmaier K, Lang AK, Ganslmayer M, Willam C, Bremer FF, Fürst J, Beyer C, Bogdan C, Rath A, Held J (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Antimicrobial Agents and Chemotherapy American Society for Microbiology

Book Volume: 67

Journal Issue: 11

DOI: 10.1128/aac.00725-23

Abstract

Candida spp. are frequently encountered in specimens from ICUs. However, most of these detections represent colonization. Nevertheless, clinical practice shows that a considerable proportion of these patients will receive antifungal therapy (AT). β-(1→3)-D-glucan (BDG) and mannan are fungal biomarkers with high negative predictive values. We aimed to examine whether biomarker-guided discontinuation of AT can reduce the antifungal consumption. Therefore, we conducted a prospective, randomized intervention study between 1 April 2019 and 31 March 2020. All adult ICU patients with a newly started systemic AT but without fungal infection were eligible for inclusion. Enrolled patients were randomized into an intervention and a control group. In both groups, serum BDG and mannan were determined on days 1 and 2 of AT. If all measurements were negative, AT was discontinued in the intervention group. The primary endpoint was antifungal use. The study was terminated after 12 months. Until this time-point, 41 patients had been included. In the intervention group (n = 19), AT was stopped in only two patients because all others showed either positive BDG and∕or mannan levels. One of these two patients developed candidemia and AT had to be restarted. There was no significant difference in the primary and secondary endpoints. In summary, the strategy of using two negative BDG and mannan levels to stop AT failed to reduce antifungal consumption in our cohort. Indeed, there will inevitably be patients with invasive candidiasis in whom necessary AT is discontinued. The optimal patient population, biomarker set, and termination criteria are critical to the success of biomarker-based termination strategies.

Authors with CRIS profile

Richard Strauss Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Alvaro Ixchel Castellanos Department of Anaesthesiology Karl Bihlmaier Department of Medicine 4 – Nephrology and Hypertension Marion Ganslmayer Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Carsten Willam Department of Medicine 4 – Nephrology and Hypertension Frank Felix Bremer Medizinische Fakultät Julia Fürst Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Christian Beyer Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Christian Bogdan Lehrstuhl für Mikrobiologie und Infektionsimmunologie Jürgen Held Institute of Microbiology – Clinical Microbiology, Immunology and Hygiene

How to cite

APA:

Erb, T., Mihai, S., Strauss, R., Herbst, L., Castellanos, I., Diesch, K.,... Held, J. (2023). β-(1→3)-D-glucan- and mannan-guided early termination of antifungal therapy in ICU patients: a randomized controlled study. Antimicrobial Agents and Chemotherapy, 67(11). https://dx.doi.org/10.1128/aac.00725-23

MLA:

Erb, Timothy, et al. "β-(1→3)-D-glucan- and mannan-guided early termination of antifungal therapy in ICU patients: a randomized controlled study." Antimicrobial Agents and Chemotherapy 67.11 (2023).

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