Negative Beta Glucan in ICU Patients
Negative Beta Glucan in ICU Patients
This is a prospective study aimed at testing a strategy of early initiation of an antifungal
 agent to patients admitted to intensive care units (ICUs) at risk for invasive candidiasis.
 Score system have been developed to identify groups at very high risk for the development of
 candidemia/invasive candidiasis in the ICU. These scoring system have used clinical
 information with or without data on Candida colonization, and have shown reasonable
 correlation with candidemia/invasive candidiasis. More recently, a biomarker - detection of
 1,3-beta-D-glucan in the serum - has been tested in the early diagnosis of candidiasis. The
 incorporation of biomarkers such as beta-D-glucan could help clinicians to select a group at
 higher risk for candidemia, and despite the fact that these tests may give false-positive
 results, their negative predictive value could be of great help.

 Therefore, the objectives of this study are:

 1. To assess the frequency of positive biomarkers in ICU patients at high risk to develop
 invasive candidiasis/candidemia;

 2. To test the strategy of early discontinuation of antifungal therapy based on repeatedly
 negative blood cultures and 1,3 beta-D-glucan in the serum.
Entry criteria are: In the ICU for >2 days AND systemic antibiotics >2 days OR central venous
 catheter for >days AND at least two of the following: total parenteral nutrition, dialysis,
 surgery, pancreatitis, receipt of corticosteroids, receipt of other immunosuppressive agents.
 In addition, patients must have a clinical sign of infection (either one of the following):
 fever, hypothermia, hypotension, unexplained acidosis, or unexplained elevation in C-reactive
 protein.

 Eligible patients will be enrolled after signing an informed consent and will have blood
 obtained for culture and determination of 1,3 beta-D-glucan serum levels for 3 days, and will
 start anidulafungin IV.

 If all tests are negative, anidulafungin will be discontinued on day 4. If 1,3 beta-D-glucan
 is positive (>80 pg/ml) and / or blood cultures are positive for Candida species,
 anidulafungin will be continued for >14 days.
Inclusion Criteria:

 -  In the ICU for >2 days AND

 -  Systemic antibiotics on days 1-3 of ICU OR

 -  Central venous catheter on days 1-3 of ICU

 -  AND at least 2 of:

 -  Total parenteral nutrition on days 1-3 of ICU

 -  Any dialysis on days 1-3 of ICU

 -  Major surgery in the 7 days before admission in the ICU

 -  Pancreatitis in the 7 days before admission in the ICU

 -  Use of corticosteroids for at least 3 days in the 7 days before admission

 -  Use of other immunosuppressive agents in the 7 days before admission in the ICU

 -  In addition, the patient must have at least one of the following:

 -  Fever (axillary temperature >37.5 oC)

 -  Hypothermia (axillary temperature <35 oC)

 -  Hypotension

 -  Unexplained acidosis

 -  Unexplained elevation in C-reactive protein

 Exclusion Criteria:

 -  Antifungal for >3 days

 -  Allergy to an echinocandin