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Reevaluating the Value of (1,3)-β-D-Glucan for the Diagnosis of Intra-Abdominal Candidiasis in Critically Ill Patients: Current Evidence and Future Directions

Summary

This review examines how a fungal biomarker called beta-D-glucan (BDG) can help doctors diagnose yeast infections in the abdomens of critically ill patients. While BDG tests in the blood are available, they give many false positives. Testing BDG directly in fluid from the abdomen appears more accurate, especially when combined with blood tests. However, more research is needed before hospitals widely adopt this approach in daily practice.

Background

Intra-abdominal candidiasis (IAC) is a significant diagnostic and therapeutic challenge in critically ill patients. Traditional fungal cultures are slow, delaying appropriate antifungal treatment. (1,3)-β-D-glucan (BDG) has emerged as a potential biomarker for IAC, but its clinical utility is complicated by frequent false-positive results.

Objective

This review examines the diagnostic value of BDG in serum and peritoneal fluid for the diagnosis of intra-abdominal candidiasis in critically ill patients. The authors assess the advantages, limitations, and practical aspects of BDG testing to establish the role of peritoneal BDG as a complementary diagnostic tool.

Results

While serum BDG is effective for excluding candidemia, its specificity for IAC remains low with high false-positive rates. Recent studies suggest peritoneal BDG provides better diagnostic accuracy with negative predictive values of 82-100% at thresholds of 45 pg/mL or lower, though significant overlap exists between fungal and bacterial infections.

Conclusion

Serum BDG testing should not be used in isolation for IAC diagnosis due to high false-positive rates. Peritoneal BDG shows promise as a complementary tool with higher specificity, particularly when combined with low serum BDG levels. Further large-scale, multicenter validation studies are needed before routine clinical implementation.
  • Published in:Journal of Fungi (Basel),
  • Study Type:Review,
  • Source: PMID: 39997386, DOI: 10.3390/jof11020091
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