The impact of anti-mould prophylaxis on Aspergillus PCR blood
testing for the diagnosis of invasive aspergillosis.

J 2021

The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis.

CRUCIANI, M., P. L. WHITE, C. MENGOLI, J. LÖFFLER, C. O. MORTON et. al.

Basic information

Original name

The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis.

Authors

CRUCIANI, M., P. L. WHITE (guarantor), C. MENGOLI, J. LÖFFLER, C. O. MORTON, L. KLINGSPOR, D. BUCHHEIDT, J. MAERTENS, W. J. HEINZ, T. R. ROGERS, Barbora WEINBERGEROVÁ (203 Czech Republic, belonging to the institution), A. WARRIS, DEA. LOCKHART, B. JONES, C. CORDONNIER, J. P. DONELLY and R. A. BARNES

Edition

Journal of Antimicrobial Chemotherapy, Oxford, Oxford University Press, 2021, 0305-7453

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30303 Infectious Diseases

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 5.758

RIV identification code

RIV/00216224:14110/21:00121104

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1093/jac/dkaa498

UT WoS

000620821900013

Keywords in English

Aspergillus PCR blood testing; invasive aspergillosis; anti-mould prophylaxis

Abstract

V originále

Background: The performance of the galactomannan enzyme immunoassay (GM-EIA) is impaired in patients receiving mould-active antifungal therapy. The impact of mould-active antifungal therapy on Aspergillus PCR testing needs to be determined. Objectives: To determine the influence of anti-mould prophylaxis (AMP) on the performance of PCR blood testing to aid the diagnosis of proven/probable invasive aspergillosis (IA). Methods: As part of the systematic review and meta-analysis of 22 cohort studies investigating Aspergillus PCR blood testing in 2912 patients at risk of IA, subgroup analysis was performed to determine the impact of AMP on the accuracy of Aspergillus PCR. The incidence of IA was calculated in patients receiving and not receiving AMP. The impact of two different positivity thresholds (requiring either a single PCR positive test result or >= 2 consecutive PCR positive test results) on accuracy was evaluated. Meta-analytical pooling of sensitivity and specificity was performed by Logistic mixed-model regression. Results: In total, 1661 (57%) patients received prophylaxis. The incidence of IA was 14.2%, significantly Lower in the prophylaxis group (11%-12%) compared with the non-prophylaxis group (18%-19%) (P< 0.001). The use of AMP did not affect sensitivity, but significantly decreased specificity [single PCR positive result threshold: 26% reduction (P= 0.005); >= 2 consecutive PCR positive results threshold: 12% reduction (P= 0.019)]. Conclusions: Contrary to its influence on GM-EIA, AMP significantly decreases Aspergillus PCR specificity, without affecting sensitivity, possibly as a consequence of AMP Limiting the clinical progression of IA and/or Leading to false-negative GM-EIA results, preventing the classification of probable IA using the EORTC/MSGERC definitions.

Citovat

CRUCIANI, M., P. L. WHITE, C. MENGOLI, J. LÖFFLER, C. O. MORTON, L. KLINGSPOR, D. BUCHHEIDT, J. MAERTENS, W. J. HEINZ, T. R. ROGERS, Barbora WEINBERGEROVÁ, A. WARRIS, DEA. LOCKHART, B. JONES, C. CORDONNIER, J. P. DONELLY and R. A. BARNES. The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis. Journal of Antimicrobial Chemotherapy. Oxford: Oxford University Press, 2021, vol. 76, No 3, p. 635-638. ISSN 0305-7453. Available from: https://dx.doi.org/10.1093/jac/dkaa498.

@article{1738798,
   author = {Cruciani, M. and White, P. L. and Mengoli, C. and Löffler, J. and Morton, C. O. and Klingspor, L. and Buchheidt, D. and Maertens, J. and Heinz, W. J. and Rogers, T. R. and Weinbergerová, Barbora and Warris, A. and Lockhart, DEA. and Jones, B. and Cordonnier, C. and Donelly, J. P. and Barnes, R. A.},
   article_location = {Oxford},
   article_number = {3},
   doi = {http://dx.doi.org/10.1093/jac/dkaa498},
   keywords = {Aspergillus PCR blood testing; invasive aspergillosis; anti-mould prophylaxis},
   language = {eng},
   issn = {0305-7453},
   journal = {Journal of Antimicrobial Chemotherapy},
   title = {The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis.},
   url = {https://academic.oup.com/jac/article-abstract/76/3/635/6055077?redirectedFrom=fulltext},
   volume = {76},
   year = {2021}
}

TY  - JOUR
ID  - 1738798
AU  - Cruciani, M. - White, P. L. - Mengoli, C. - Löffler, J. - Morton, C. O. - Klingspor, L. - Buchheidt, D. - Maertens, J. - Heinz, W. J. - Rogers, T. R. - Weinbergerová, Barbora - Warris, A. - Lockhart, DEA. - Jones, B. - Cordonnier, C. - Donelly, J. P. - Barnes, R. A.
PY  - 2021
TI  - The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis.
JF  - Journal of Antimicrobial Chemotherapy
VL  - 76
IS  - 3
SP  - 635-638
EP  - 635-638
PB  - Oxford University Press
SN  - 03057453
KW  - Aspergillus PCR blood testing
KW  - invasive aspergillosis
KW  - anti-mould prophylaxis
UR  - https://academic.oup.com/jac/article-abstract/76/3/635/6055077?redirectedFrom=fulltext
N2  - Background: The performance of the galactomannan enzyme immunoassay (GM-EIA) is impaired in patients receiving mould-active antifungal therapy. The impact of mould-active antifungal therapy on Aspergillus PCR testing needs to be determined. Objectives: To determine the influence of anti-mould prophylaxis (AMP) on the performance of PCR blood testing to aid the diagnosis of proven/probable invasive aspergillosis (IA). Methods: As part of the systematic review and meta-analysis of 22 cohort studies investigating Aspergillus PCR blood testing in 2912 patients at risk of IA, subgroup analysis was performed to determine the impact of AMP on the accuracy of Aspergillus PCR. The incidence of IA was calculated in patients receiving and not receiving AMP. The impact of two different positivity thresholds (requiring either a single PCR positive test result or >= 2 consecutive PCR positive test results) on accuracy was evaluated. Meta-analytical pooling of sensitivity and specificity was performed by Logistic mixed-model regression. Results: In total, 1661 (57%) patients received prophylaxis. The incidence of IA was 14.2%, significantly Lower in the prophylaxis group (11%-12%) compared with the non-prophylaxis group (18%-19%) (P< 0.001). The use of AMP did not affect sensitivity, but significantly decreased specificity [single PCR positive result threshold: 26% reduction (P= 0.005); >= 2 consecutive PCR positive results threshold: 12% reduction (P= 0.019)]. Conclusions: Contrary to its influence on GM-EIA, AMP significantly decreases Aspergillus PCR specificity, without affecting sensitivity, possibly as a consequence of AMP Limiting the clinical progression of IA and/or Leading to false-negative GM-EIA results, preventing the classification of probable IA using the EORTC/MSGERC definitions.
ER  -

CRUCIANI, M., P. L. WHITE, C. MENGOLI, J. LÖFFLER, C. O. MORTON, L. KLINGSPOR, D. BUCHHEIDT, J. MAERTENS, W. J. HEINZ, T. R. ROGERS, Barbora WEINBERGEROVÁ, A. WARRIS, DEA. LOCKHART, B. JONES, C. CORDONNIER, J. P. DONELLY and R. A. BARNES. The impact of anti-mould prophylaxis on Aspergillus PCR blood testing for the diagnosis of invasive aspergillosis. \textit{Journal of Antimicrobial Chemotherapy}. Oxford: Oxford University Press, 2021, vol.~76, No~3, p.~635-638. ISSN~0305-7453. Available from: https://dx.doi.org/10.1093/jac/dkaa498.

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