-Glucan Antigenemia Assay for the Diagnosis of Invasive Fungal Infections in Patients With Hematological Malignancies: A Systematic Review and Meta-Analysis of Cohort Studies From the Third European Conference on Infections in Leukemia (ECIL-3)

Lamoth, Frédéric; Cruciani, Mario; Mengoli, Carlo; Castagnola, Elio; Lortholary, Olivier; Richardson, Malcolm; Marchetti, Oscar

doi:10.1093/cid/cir897

Cited by 260 publications

(179 citation statements)

References 37 publications

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“…Sensitivities are higher for infections caused by C. albicans than by other Candida species. Commercially available BDG assays had sensitivities of 73-75% and specificities of 97% for the diagnosis of probable or proven Candida infections [35].…”

Section: Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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Purpose:To describe concisely the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to Candida and Aspergillus infections in non-neutropenic patients in the ICU setting. Methods:A systematic review of the medical literature taking account of national and international guidelines and expert opinion. Results:Severe invasive fungal infections (IFIs) are becoming increasingly frequent in critically ill patients. Approximately 80% of IFIs are due to Candida spp. and 0.3-19% to Aspergillus spp. Recent observations emphasize the necessity of building a worldwide sentinel network to monitor the emergence of new fungal species and changes in susceptibility. Robust data on the attributable mortality are essential for the design of clinical studies with mortality endpoints. Although early antifungal therapy for Candida has been recommended in patients with risk factors, sepsis of unknown cause, and positive Candida serum biomarkers [β-1 → 3-d-glucan (BDG) and Candida albicans germ tube antibody (CAGTA)], its usefulness and influence on outcome need to be confirmed. Future studies may specifically address the optimal diagnostic and therapeutic strategies for patients with abdominal candidiasis. Better knowledge of the pharmacokinetics of antifungal molecules and tissue penetration is a key issue for intensivists. Regarding invasive aspergillosis, further investigation is needed to determine its incidence in the ICU, its relationship with influenza outbreaks, the clinical impact of rapid diagnosis, and the significance of combination treatment. Conclusions:Fundamental questions regarding IFI have to be addressed over the next decade. The clinical studies described in this research agenda should provide a template and set priorities for the clinical investigations that need to be performed.

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Section: Invasive Candidiasismentioning

confidence: 99%

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

et al. 2017

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“…Owing to variable sensitivity, specificity and predictive values, the BG test should be used for clinical management decisions in conjunction with clinical, microbiological and radiological findings. 27 Additional analyses are needed to determine the optimal cutoff values and the number of positive samples defining a positive test. Performance analyses should be investigated in cohort studies that better reflect the utility of the test in populations targeted in its real-life clinical application.…”

Section: Biological Factors Epidemiological Factorsmentioning

confidence: 99%

“…Issues regarding the technical complexity of the assay and the cost-effectiveness of its use should also be considered for its real-time implementation for guiding clinical management. 27 …”

Section: Biological Factors Epidemiological Factorsmentioning

confidence: 99%

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

Marchetti

Lamoth

Mikulska

et al. 2011

Bone Marrow Transplant

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“…61,62 With respect to serum BDG and GM assays, several meta-analyses have noted heterogeneity of results attributed to differences in study design, patient populations (e.g., hematologic vs other), the criteria used to define a positive test, and the definition of IA. [63][64][65][66][67][68] Among highrisk patients with hematologic malignancies and chemotherapy-induced neutropenia or allogeneic HCT, both tests share a similar sensitivity of 60%-80% and specificity of 90% and higher. 69 There may also be a role for combining serum BDG and GM screening in high-risk neutropenic patients.…”

Section: Improving Diagnosis Of Invasive Aspergillosismentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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-Glucan Antigenemia Assay for the Diagnosis of Invasive Fungal Infections in Patients With Hematological Malignancies: A Systematic Review and Meta-Analysis of Cohort Studies From the Third European Conference on Infections in Leukemia (ECIL-3)

Cited by 260 publications

References 37 publications

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

Intensive care medicine research agenda on invasive fungal infection in critically ill patients

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

Antifungal stewardship considerations for adults and pediatrics

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