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Background  While  Candida  pneumonia is life-threatening, biomarker measurements to early detect suspected  Candida  pneumonia are lacking. This study compared the diagnostic values of measuring levels of (1, 3)-β-D-glucan in endotracheal aspirate, bronchoalveolar lavage fluid, and serum to detect suspected  Candida  pneumonia in immunocompromised and critically ill patients.    Methods  This prospective, observational study enrolled immunocompromised, critically ill, and ventilated patients with suspected fungal pneumonia in mixed intensive care units from November 2010 to October 2011. Patients with D-glucan confounding factors or other fungal infection were excluded. Endotracheal aspirate, bronchoalveolar lavage fluid and serum were collected from each patient to perform a fungal smear, culture, and D-glucan assay.    Results  After screening 166 patients, 31 patients completed the study and were categorized into non- Candida  pneumonia/non-candidemia ( n  = 18), suspected  Candida  pneumonia ( n  = 9), and non- Candida  pneumonia/candidemia groups ( n  = 4). D-glucan levels in endotracheal aspirate or bronchoalveolar lavage were highest in suspected  Candida  pneumonia, while the serum D-glucan level was highest in non- Candida  pneumonia/candidemia. In all patients, the D-glucan value in endotracheal aspirate was positively correlated with that in bronchoalveolar lavage fluid. For the detection of suspected  Candida  pneumonia, the predictive performance (sensitivity/specificity/D-glucan cutoff [pg/ml]) of D-glucan in endotracheal aspirate and bronchoalveolar lavage fluid was 67%/82%/120 and 89%/86%/130, respectively, accounting for areas under the receiver operating characteristic curve of 0.833 and 0.939 (both  P  < 0.05), respectively. Measuring serum D-glucan was of no diagnostic value (area under curve =0.510,  P  = 0.931) for the detection of suspected  Candida  pneumonia in the absence of concurrent candidemia.    Conclusions  D-glucan levels in both endotracheal aspirate and bronchoalveolar lavage, but not in serum, provide good diagnostic values to detect suspected  Candida  pneumonia and to serve as potential biomarkers for early detection in this patient population.    Electronic supplementary material  The online version of this article (doi:10.1186/s12879-017-2364-2) contains supplementary material, which is available to authorized users.

bmc infectious diseases

Measuring (1,3)-β-D-glucan in tracheal aspirate, bronchoalveolar lavage fluid, and serum for detection of suspected Candida pneumonia in immunocompromised and critically ill patients: a prospective observational study