Desempenho da (1,3)-β-d-glucana no diagnóstico de candidemia e sua cinética durante terapêutica antifúngica

• Ano de defesa: 2016
• Autor(a) principal: Esteves, Patricia [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Candida; Candidemia; D-glucana
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4046077; http://repositorio.unifesp.br/handle/11600/46394

Candidemia is a major cause of bloodstream infections in tertiary hospitals worldwide and is associated with high rates of morbidity and mortality. Early diagnosis and treatment are essential to reduce mortality of this infection. The detection of (1-3)-β- D-Glucan in the blood of patients with fungaemia seems to be a tool with great potential in the diagnosis of this mycosis. The objectives of this study were to evaluate the performance of (1-3)-β-D-Glucan in the diagnosis of patients with candidemia, identify putative factors associated with false-negative test results, recognize predictive factors of poor clinical response to antifungal treatment and evaluate the impact of treatment on the kinetics of (1-3)-β-D-Glucan. We conducted cohort study with three experimental designs: a) A cross-sectional, retrospective, cohort study to assess the accuracy of the test (1-3)-β-D-Glucan in the diagnosis of patients with candidemia; b) a longitudinal cohort to analyze the kinetics of the (1-3)-β-D-Glucan in patients with candidemia with successfully or poor response to antifungal therapy; c) case-control study to identify variables related to the occurrence of false-negative results of (1,3)-β-D-Glucan in patients with candidemia. The study was conducted at 3 hospitals from June 2010 to February 2015. During this period we enrolled a total of 71 patients with candidemia and 120 patients without invasive fungal disease as a control group. The detection of (1-3)-β-D-Glucan was performed by using Fungitell®. In the group of patients with candidemia, the results of (1-3)-β-D-Glucan collected at diagnosis of fungaemia had a mean of 588 pg/mL, with 51 positive results and 20 false-negative results. In the control group there were 110 negative and 10 false-positive results. The sensitivity, specificity, positive and negative predictive values were: 71.8%; 91.6%; 83.6% and 84.6%, respectively. No independent variable was associated with false-negative results. Among 71 patients with candidemia, 20 subjects exhibited poor response to treatment. The only predictor of poor response to treatment in the present study was the initial value of (1,3)-β-D-Glucan > 226 pg/mL. The average values of (1,3)-β-DGlucan evaluated three times during treatment were different between patients with poor response to therapy and those with therapeutic success. In conclusion, the performance of (1,3)-β-D-Glucan for the diagnosis of candidemia was similar to those described in previous studies. Furthermore, we noted that high initial values of (1,3)-β-D-Glucan were associated with poor therapeutic response, suggesting that it could be a useful tool in the early recognition of patients most likely to present therapeutic failure.