(1-3)-beta-D-glucan levels in candidiasis infections in the critically ill neonate

Introduction: The diagnosis of neonatal invasive Candida infections (ICIs) is problematic because the clinical signs are not specific and blood cultures are rarely positive. Hence, new diagnostic markers are needed. Objective: To assess the contribution of serum (1-3)-beta-D-glucan (BDG) levels to the diagnosis of neonatal ICIs and to analyse the change in this parameter during antifungal therapy. Methods: This retrospective study (December 2010-March 2012) was performed at Amiens University Medical Center (Amiens, France). We included newborns in whom a BDG assay was performed for a suspected ICI and classified as infected (n = 18) or non-infected (n = 43). Results: Sixty-one patients (median (IQR) gestational age: 28.5 weeks (26.7-30.6); birth weight: 1000 g (910-1440)) were included. The BDG level was higher in the infected group (364 pg/ml (131-976) vs. 89 pg/ml (30-127); p < 0.001). The optimal BDG cut-off for distinguishing between non-infected and infected patients was 125 pg/ml (Se = 84%, Sp = 75%). The BDG level fell over the course of antifungal therapy. Conclusion: Our study results suggest that BDG levels were increased in neonatal invasive Candida infections (cut-off for BDG positivity > 125 pg/ml). The change in the serum BDG levels may be of value in evaluating the efficacy of antifungal therapy.