252. Initial High Serum (1,3) -D-Glucan (BDG) in Hospitalized Adult Patients: Impact on Treatment Outcomes and Hospital Mortality
Session: Poster Abstract Session: Diagnostics: Mycology
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDweek 2015 - BDG.pdf (412.2 kB)
  • Background: High serum BDG levels may correspond with an initial high fungal burden and may influence antifungal treatment response. To this effect, we analyzed such potential relationship in patients at our tertiary care medical center.

    Methods: All positive BDG (Fungitell®, Associates of Cape Cod, Inc.) in adults between January 2013 and January 2015 were assessed retrospectively. Standard EORTC definitions were used. Treatment failure was defined as death within 42 days after antifungal therapy commenced, persistence of clinical presentation for invasive fungal disease (IFD) and/or persistent positive fungal cultures. Chi-square, Mann-Whitney U and Kruskal-Wallis tests assisted in data analysis. BDG was measured in pg/ml; >70 pg/ml was upper normal limit (UNL) and 5x UNL was regarded as high BDG values.

    Results: Sixty-three patients (all proven or probable IFD) were given systemic antifungal therapy, treatment failed in 12 (38%) patients with high initial BDG and 13 (42%) patients with low initial BDG (P=0.8). Initial BDG levels and relationship with treatment failure and hospital mortality are as follows:  
    Initial BDG levels Number of patients (N = 275) Univariate analysis Multivariate analysis 
    Died                       (N = 97) Alive (N=178) P-value OR (95% CI) P-value OR 95% CI
    ≥2x ULN 65 (67) 115 (65) 0.8 1.1 (0.66 - 1.88) 0.9 0.9 (0.48 - 1.70)
    ≥3x ULN 43 (44) 89 (50) 0.4 0.8 (0.49 - 1.31) 0.5 0.8 (0.35 - 1.70)
    ≥4x ULN 37 (38) 76 (43) 0.5 0.8 (0.50 - 1.37) 0.2 0.7 (0.37 - 1.26)
    ≥5x ULN 31 (32) 63 (35) 0.7 0.9 (0.51 - 1.45) 0.3 0.7 (0.38 - 1.38)
    Initial BDG levels Number of patients (N = 63) Univariate analysis Multivariate analysis 
    Treatment failed                      (N = 25) Treatment success             (N=38) P-value OR 95% CI P-value OR 95% CI
    ≥2x ULN 19 (76) 29 (76) 1 0.9 (0.30 - 3.21) 0.6 1.5 (0.31 - 7.32)
    ≥3x ULN 16 (64) 26 (68) 0.7 0.8 (0.28 - 2.38) 0.3 2.2 (0.49 - 9.97)
    ≥4x ULN 15 (60) 20 (53) 0.7 1.4 (0.49 - 3.75) 0.8 0.9 (0.21 - 3.55)
    ≥5x ULN 12 (48) 20 (53) 0.9 0.8 (0.30 - 2.28) 0.5 0.6 (0.16 - 2.46)

    Conclusion: Initial high BDG levels were not related with failure to antifungal therapy or death.

    John Rague, Medical Student1, John Huang, MD2, Salman Khan, MD2, Yanina Dubrovskaya, PharmD3, Robert Press, MD, PhD4 and Amar Safdar, MD5, (1)NYU SOM, New York, NY, (2)NYU Langone Medical Center, New York, NY, (3)Department of Pharmacy, NYU Langone Medical Center, New York, NY, (4)Infectious Diseases, New York University School of Medicine, New York, NY, (5)Infectious Diseases and Immunology, New York University Langone Medical Center, New York, NY

    Disclosures:

    J. Rague, None

    J. Huang, None

    S. Khan, None

    Y. Dubrovskaya, None

    R. Press, None

    A. Safdar, None

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