Species-Specific Sensitivity and Levels of Beta-D-Glucan for the Diagnosis of Candidemia—A Systematic Review and Meta-Analysis
Background: 1, 3-ß-D-Glucan (BDG) is an antigen present in the cell wall of many pathogenic fungi and is used as a marker for the early diagnosis of candidemia and discontinuation of empirical treatment. Changes in the epidemiology of <i>Candida</i> species might have a negative impact o...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-02-01
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| Series: | Journal of Fungi |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2309-608X/11/2/149 |
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| Summary: | Background: 1, 3-ß-D-Glucan (BDG) is an antigen present in the cell wall of many pathogenic fungi and is used as a marker for the early diagnosis of candidemia and discontinuation of empirical treatment. Changes in the epidemiology of <i>Candida</i> species might have a negative impact on the performance of serum BDG. The aim of this study was to analyze the performance of BDG in candidemia diagnosis focusing on species-specific differences in BDG sensitivity and BDG levels. Methods: The PRISMA system was used for the systematic search. The following databases were searched for articles published from January 2010 to November 2023: PubMed, Science Direct, and Scopus. Results: A total of 21 studies that met the inclusion criteria were included, reporting data from 1633 patients with candidemia; 11 reported both sensitivity and specificity, 15 reported species-specific sensitivity, and nine reported species-specific BDG levels. The pooled sensitivity of BDG in all studies was 0.73 (95% confidence interval (CI), 0.66-0.80), while the pooled sensitivity and specificity in 11 studies were 0.81 (95% CI 0.73-0.89) and 0.80 (95% CI 0.74-0.87). BDG pooled sensitivity (all assays) and BDG levels (for assays with cutoff of 80 pg/mL) were the highest in <i>C. krusei</i> (currently <i>Pichia kudriavzevii</i>) and the lowest in <i>C. auris</i>: 0.76 and 417 pg/mL for <i>C. krusei</i>, 0.73 and 345 pg/mL for <i>C. albicans</i>, 0.74 and 356 pg/mL for <i>C. glabrata</i> (currently <i>Nakaseomyces glabrata</i>), 0.70 and 324 pg/mL for <i>C. tropicalis</i>, 0.63 and 95 pg/mL for <i>C. parapsilosis,</i> 0.51 and 62 pg/mL for <i>C. auris,</i> and 0.44 and 79 pg/mL for other <i>Candida</i> species. These differences were statistically significant for BDG sensitivity and levels of <i>C. albicans</i>, <i>C. glabrata</i>, <i>C. krusei</i>, and <i>C. tropicalis</i> compared to <i>C. auris</i>, <i>C. parapsilosis</i>, and other <i>Candida</i> species. Conclusion: The sensitivity of BDG in candidemia diagnosis depends on the <i>Candida</i> species, with the lowest being for <i>C. auris</i> and <i>C. parapsilosis</i>. This might have a clinical impact in centers where these species are prevalent. |
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| ISSN: | 2309-608X |