Reevaluating the Value of (1,3)-β-D-Glucan for the Diagnosis of Intra-Abdominal Candidiasis in Critically Ill Patients: Current Evidence and Future Directions.

Intra-abdominal candidiasis (IAC) is associated with significant diagnostic and therapeutic challenges in critically ill patients. Traditional fungal cultures are slow, delaying appropriate antifungal treatment. (1,3)-β-D-glucan (BDG), a component of the fungal cell wall, has emerged as a potential biomarker for IAC, but its use in ICU settings is complicated by frequent false-positives results from invasive procedures and underlying conditions. This review examines the diagnostic value of BDG when present in serum and peritoneal fluid. While serum BDG is effective for excluding invasive fungal infections like candidemia, its specificity for IAC remains low in critically ill patients. Recent studies suggest that BDG levels in peritoneal fluid may provide better diagnostic accuracy, distinguishing IAC from bacterial peritonitis with higher specificity. We discuss the advantages, limitations, and practical aspects of BDG testing, emphasizing the potential of peritoneal BDG as a complementary tool. Further research is needed to refine diagnostic thresholds, validate its clinical utility, and establish the role of peritoneal BDG in improving timely, targeted antifungal treatment for IAC.