IDWeek 2019 — Low predictive value of beta-D-glucan in hematology patients on antifungal prophylaxis


  • Devona Williams, Pharm.D.
  • Conference Reports
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Takeaway

  • Beta-D-glucan has a low positive predictive value for diagnosis of invasive fungal infection in hematology patients prescribed antifungal prophylaxis.

Why this matters

  • Patients treated with induction chemotherapy or stem cell transplant for hematologic malignancies require antifungal prophylaxis.
  • Beta-D-glucan (BDG) is a common method of surveillance for diagnosis of suspected invasive fungal infections.

Study design

  • Retrospective chart review of all BDG results in hematology patients receiving posaconazole or micafungin prophylaxis.
  • BDG results were categorized at true-positive, true-negative, false-positive, or false-negative.
  • Indications for diagnostic screening:
    • Neutropenic fever >5 days in setting of broad-spectrum antibacterial agents.
    • Clinical symptoms and diagnostic imaging suggesting fungal infection.

Key results

  • Most patients had received either a stem cell transplant (49.7%) or induction chemotherapy (43.8%).
  • The rate of true-positive BDG confirmation of infection was low. 
  • The negative predictive value of BDG was 95.7%.
  • The sensitivity was 42.9% and the specificity was 88.1%.
  • BDG was useful in excluding fungal infection, but not effective for infection diagnosis.

Limitations

  • Single-center, retrospective chart review.
  • Results presented at a conference and not peer-reviewed.