Utility of Serum (1,3)-β-D-glucan in Diagnosing and Treating Fungal Infections in Patients with Burn Injury

Authors:
Jeffrey Shupp, Lauren Moffatt, Melissa McLawhorn, Salma Hassan, Shawn Tejiram, Taryn Travis

Body of Abstract:
Introduction
Invasive fungal infections are life-threatening and occur in immunocompromised or critically ill patients. Patients with severe burn injuries are at increased risk for developing invasive fungal infection. Fungal infections are independently associated with increased mortality in burn patients, making early detection in this population paramount. Conventional methods of fungal culture may be unable to detect invasive fungal infection or result in delayed diagnosis. Fungitell® is a diagnostic test that detects (1, 3)-β-D-glucan (BDG) in serum to help diagnose invasive fungal infections. There is a paucity of literature examining the use of BDG assays in burn injured patients to diagnose invasive fungal infection. The aim of this work was to examine the use of BDG assays in a population of severe burn injured patients to determine its utility in guiding antifungal use as well as patient outcomes at a single institution.
Methods
Patients admitted at a single burn center with severe burn injuries estimated to be 15% total body surface area (TBSA) of burn or greater from July 2019 to June 2024 were retrospectively examined. Medical records were reviewed for demographics, injury characteristics, BDG levels, use of antifungals, presence of concomitant bacterial infections, antibiotic therapy, resolution of infection, and mortality. Friedman’s test was used to compare BDG levels across multiple measurements following the initiation of antifungal treatment. A Spearman’s correlation test to analyze the correlation between initial BDG levels and duration of antifungal treatment.
Results
During the study period, 44 patients had BDG levels reported. Of these patients, the most common etiology of burn injury was flame (84.4%). The median (IQR) total body surface area of burn injury was 33.4% (24.8-47.5). Overall mortality rate was 52.3%. Of the patients that had BDG levels measured, 37 were started on antifungal treatment after the initial level was collected (84.1%). Of these patients, only 12 (32.4%) had culture data positive for fungal infection. Discontinuation of treatment was guided by decreasing or negative BDG levels in 73.3% of patients. Among patients with three or more BDG levels obtained, there were increased BDG levels from the first to second measurements [123 (51.75-201.0) vs 159 (113.5-238.8); p=0.007]. However, levels decreased between the second and third measurements [159 (113.5-238.8) vs 126 (85.0-252.0); p=0.004] (Figure 1). There is a weak correlation between initial BDG level and the duration of antifungal treatment (Spearman ρ =0.3194, 95% CI 0.01579-0.5690; p=0.0173).
Conclusion
This data demonstrates that patients were initiated on antifungal treatment after collection of initial BDG level and continued despite negative culture data in many patients, suggesting the utility of BDG assay to guide antifungal use in patients with burn injury. Further study is necessary to elucidate best practices in BDG level use.