Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Douglas, Abby; Smibert, Olivia C; Bajel, Ashish; Halliday, Catriona; Lavee, Orly; McMullan, Brendan; Yong, Michelle K.; Hal, Sebastiaan J. van; Chen, Sharon C.‐A.

doi:10.1111/imj.15591

Cited by 93 publications

(75 citation statements)

References 297 publications

(385 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The significant reduction in escalation to treatment antifungal therapy is largely responsible for the difference in LAmB usage between the groups. LAmB is currently recommended as the empirical antifungal agent of choice when an IFI is suspected in patients on mould active azole prophylaxis 13,32,33 . Reduction in use of LAmB is beneficial in alloHCT, due to significant rates of nephrotoxicity seen in this patient group.…”

Section: Discussionmentioning

confidence: 99%

Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches

Selby

Warner

Peake

et al. 2022

Transplant Infectious Dis

Self Cite

View full text Add to dashboard Cite

Background Limited consensus exists on the optimal use of antifungal agents to prevent invasive fungal infection in the early post allogeneic hematopoietic stem cell transplant (alloHCT) period, particularly when patients cannot tolerate oral medication administration. Methods We undertook a retrospective observational cohort study to assess the tolerability, efficacy, and cost of a new antifungal prophylaxis pathway at a major tertiary alloHCT centre. Patients aged ≥16 years who underwent alloHCT between February 2018 and October 2019 (cohort 1) or between April 2020 and November 2021 (cohort 2) were included. In both cohorts, first line prophylactic therapy was oral posaconazole. The second line drugs where oral therapy was unable to be administered were intravenous voriconazole (cohort 1) versus intravenous posaconazole (cohort 2). Results There were 142 patients enrolled in the study, 71 in each cohort. The proportion of patients remaining on first‐line prophylaxis or progressing to second‐, third‐, and fourth‐line options was 22.5%, 39.4%, 29.6%, and 8.5% in cohort 1 and 39.4%, 59.2%, 1.4%, and 0% in cohort 2, respectively. The frequency of neuropsychiatric adverse events was significantly higher in cohort 1 compared to cohort 2 (49.3% vs. 19.8%, p = .0004). Occurrence of proven and probable fungal infections was not significantly different between cohorts. Antifungal drug expenditure was $359 935 (AUD) more in cohort 1 ($830 486 AUD) compared to cohort 2 ($477 149 AUD). Conclusion The antifungal prophylaxis pathway used in cohort 2 resulted in reduced antifungal‐associated adverse effects, less patients requiring progression to 3rd and 4th line prophylaxis and reduced antifungal drug costs.

show abstract

Section: Discussionmentioning

confidence: 99%

Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches

Selby

Warner

Peake

et al. 2022

Transplant Infectious Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Errors were defined as minor (MiE), indicating that the result was intermediate/inconclusive in one assay and negative or positive in the other, major (MaE), indicating a false-positive result (negative by the FA and positive by the DFA), and very major (VmE), indicating a false-negative result (positive by the FA and negative by the DFA). Furthermore, considering that GM serves as a surrogate marker for IA [ 8 – 11 ], the DFA-BDG concentrations were also compared with the corresponding GM indices, after excluding patients who developed other fungal or bacterial infections associated with elevated BDG titers during the sampling period [ 28 ]. (3) Diagnostic evaluation The BDG results generated by the two assays were grouped according to the stratification of IA.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, screening strategies using culture-independent methods, characterized by rapid turnaround times, enhanced sensitivity, and relative ease of use, are important adjunctive diagnostic tools [ 7 ]. Although screening for circulating galactomannan (GM) has been endorsed as a standard non-invasive tool for IA diagnosis [ 8 – 11 ], remarkable variability in GM sensitivity has been associated with the underlying disease [ 12 ] and the administration of mold-active antifungal therapy [ 13 ]. Given the challenges in the diagnostic process of IA arising from the fact that none of the current assays (serological or molecular) alone are able to confirm the infection, several studies have recommended the application of combined biomarker screening in high-risk hematology patients [ 14 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Dynamiker® Fungus (1–3)-β-d-Glucan Assay for the Diagnosis of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies

et al. 2022

View full text Add to dashboard Cite

Introduction The Dynamiker ® Fungus (1–3)- β - d -glucan assay (DFA) allows the testing of samples in smaller batches compared to the well-established Fungitell ® assay (FA) making the assay cost-effective in centers with small numbers of samples. Evaluations of its performance for the diagnosis of invasive aspergillosis (IA) are limited. Therefore, we compared the two assays and evaluated their clinical performance in diagnosing IA. Methods A total of 60 adult hematology patients were screened for IA, 13 with probable IA, 19 with possible IA, and 28 with no IA. Serum specimens ( n = 166) were collected twice-weekly and tested for (1–3)- β - d -glucan (BDG) using FA and DFA which were compared quantitatively with Spearman rank correlation analysis and qualitatively with the Chi-square test. Agreement and error rates were determined using FA as the reference method. Sensitivity, specificity, and positive predictive and negative predictive values in diagnosing IA were calculated. Results The performance of the DFA was highly consistent with that of the FA, both quantitatively ( r s = 0.913) and qualitatively (kappa = 0.725). The agreement was 85% with 8% minor, no major, and 7% very major errors (FA+/DFA−). Using a cut-off value of 20 pg/mL for DFA, very major errors were reduced to 1%, although 5% major errors were detected. BDG levels were lower with DFA than FA (slope 0.653 ± 0.031). Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) was 67%, 53%, 44%, and 74% for FA, and 53%, 67%, 49%, and 71% for DFA, respectively. The optimal BDG positivity threshold calculated did not lead to significant test quality improvement for either assay. However, a higher % of patients with probable IA (62%) had ≥ 2 consecutive positive specimens compared to patients with no IA (FA-BDG 26%, p = 0.10, and DFA-BDG 10%, p = 0.01) leading to improved sensitivity and NPV (71% and 85% for DFA, and 95% and 96% for FA, respectively). Conclusion DFA could be a valuable alternative to the FA, particularly in laboratories with small numbers of samples. The results of the BDG testing should be carefully interpreted in the high-risk setting of patients with hematologic malignancies. Higher NPV was found using as criterion ≥ 2 consecutive positive samples for diagnosing IA.

show abstract

“…Most strains of Aspergillus are harmless, but some can cause severe disease, particularly among immunocompromised patients. 1 Invasive pulmonary aspergillosis commonly occurs in hematologic cancer but also in solid cancer. Invasive aspergillosis is commonly associated with hematologic malignancies and solid tumors 2 , 3 and is also encountered in children with cancer.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Aspergillosis in Cancer Patients in Taiwan

Chen¹,

Ho²,

Wu³

et al. 2022

IDR

View full text Add to dashboard Cite

Purpose The incidence of aspergillosis is increasing, and the risk factors for infection include cancer, admission to the intensive care unit, chronic pulmonary diseases, immunocompromised status, and taking immunomodulatory drugs. There are limited data about the incidence of aspergillosis in patients with different types of cancer. The aim of our study was to survey the incidence of aspergillosis in different cancer types from 2006 to 2017. Patients and Methods Data were collected from the Taiwan Cancer Registry database and International Classification of Diseases, 9th, 10th Revision, and Clinical Modification codes for diagnosing aspergillosis. Patients with a history of aspergillosis before cancer were excluded, and the secondary outcome was the risk of mortality in cancer patients with and without aspergillosis after 1 year. Results Among 951 cancer patients with a diagnosis of aspergillosis, there were 614 hematopoietic and reticuloendothelial system patients, 100 lung cancer patients, and 73 lymphoma cancer patients. The overall incidence rates of aspergillosis tended to increase significantly from 2006 to 2017 (from 3.50 to 13.37 per 10,000 person-years, p value: <0.0001). Regarding sex, the incidence rates of aspergillosis in males and females were 12.52 and 7.53 per 10,000 person-years, respectively. Patients with a diagnosis of aspergillosis had a 2.30-fold (95% CI: 2.14–2.48, p value: <0.0001) higher risk of mortality than those without aspergillosis. Conclusion The incidence of aspergillosis was increased in cancer patients, and cancer patients with aspergillosis had a significantly higher risk of mortality than those without aspergillosis.

show abstract

Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021

Cited by 93 publications

References 297 publications

Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches

Optimizing antifungal prophylaxis in allogeneic stem cell transplantation: A cohort study of two different approaches

Evaluation of the Dynamiker® Fungus (1–3)-β-d-Glucan Assay for the Diagnosis of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies

Epidemiology of Aspergillosis in Cancer Patients in Taiwan

Contact Info

Product

Resources

About