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Table 1 Empirical antifungal therapy initiated for patients with severe sepsis despite broad-spectrum antibiotics or septic shock: management of positive BDG results in the absence of formal IC documentation

From: Letter on “(1,3)-β-d-Glucan-based empirical antifungal interruption in suspected invasive candidiasis: a randomized trial”

Clinical setting

IC prevalence

(pretest probability)

BDG PPVb

(posttest probability)

Role/impact of BDGc

Management of positive BDG resultsd

CS < 3/CCI < 0.5

< 10%

< 20%

No

Consider stop AF if negative cultures (whatever BDG results)

CS ≥ 3/CCI ≥ 0.5

10–20%

20–40%

Moderate

Consider stop AF or short AF therapy (5–7 days) if negative cultures and no suspected/documented uncontrolled source of infection

Consider AF continuation (treat-like IC) in specific situations, e.g. suspected/documented uncontrolled source of infection and no culture available

Complicated abdominal surgerya

30–40%

50–70%

Yes

Consider AF continuation (treat-like IC)

  1. a(i) Anastomotic leakage, (ii) recurrent gastrointestinal perforation or severe necrotising pancreatitis, (iii) recent abdominal surgery (< 7 days) and total parenteral nutrition and ongoing broad-spectrum antibiotic [4, 5]
  2. bBDG PPV calculated according to IC prevalence for a specificity of 70–80%
  3. cAssessment of the role of BDG takes into consideration a turnaround time for BDG results of 2–3 days (similar to culture in real laboratory workflow conditions)
  4. dThe negative predictive value of BDG is considered as > 90% in all settings, and AF interruption should be considered in all cases if negative BDG
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Critical Care

ISSN: 1364-8535