Serum Galactomannan-Based Early Detection of Invasive Aspergillosis in Hematology Patients Receiving Effective Antimold Prophylaxis
Serum Galactomannan-Based Early Detection of Invasive Aspergillosis in Hematology Patients Receiving Effective Antimold Prophylaxis
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DOI：
10.1093/cid/ciu673
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发表时间：
2014-12-15
影响因子：
11.8
通讯作者：
Cuenca-Estrella, Manuel
中科院分区：
文献类型：
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作者：
Duarte, Rafael F.;Sanchez-Ortega, Isabel;Cuenca-Estrella, Manuel
背景。有实际需要研究血清半乳甘露聚糖（GM）测定在有效抗霉预防后侵袭性曲霉病潜在低检测前风险血液学患者中的性能。我们提出了一项为期4年的研究，包括262例未选择的连续高风险发作，前瞻性地使用泊沙康唑一级预防治疗和统一的诊断算法，包括双周血清GM定量检测以早期发现侵袭性曲霉菌病。总共进行了2972次血清GM检测（中位数，每发作11次[范围，3-30]）；绝大多数阴性（96.7%的检测和83.6%的发作）。突破性侵袭性曲霉病的发生率为1.9%(5/262)，均为GM检测结果真阳性。我们的研究确定了30次假阳性的GM可评估发作（85.7%，占所有可评估发作的13.8%），用实际数据验证了该检测在这种情况下的低阳性预测值（12%）。在这30例病例中的26例（86.7%）中，假阳性结果仅发生在作为预防性监测的检测中。相反，在可评估的GM试验阳性和临床怀疑侵袭性真菌疾病的病例中，诊断驱动的GM试验的性能得到改善，阳性预测值为89.6%。在有效抗霉药预防的背景下，侵袭性曲霉病的低检测前风险使得对无症状患者的血清GM监测不可靠，因为所有结果可能是阴性或假阳性。该检测对于诊断临床怀疑有侵袭性真菌疾病的患者仍然有用，因此需要在这种临床环境中更有效地结合有效预防和GM检测。
Background. There is a practical need to investigate the performance of the serum galactomannan (GM) assay in hematology patients with a potentially low pretest risk of invasive aspergillosis following effective antimold prophylaxis.Methods. We present a 4-year study with 262 unselected consecutive high-risk episodes, prospectively managed with posaconazole primary prophylaxis and a uniform diagnostic algorithm, including biweekly serum GM quantification for early detection of invasive aspergillosis.Results. A total of 2972 serum GM tests were performed (median, 11 per episode [range, 3-30]); the vast majority were negative (96.7% of tests and 83.6% of episodes). The incidence of breakthrough invasive aspergillosis was 1.9% (5/262), all with true-positive GM test results. Our study identified 30 false-positive GM evaluable episodes (85.7%; 13.8% of all evaluable episodes), validating with real-life data the low positive predictive value of the assay in this setting (12%). In 26 of these 30 episodes (86.7%), the false-positive result(s) occurred in tests performed as preemptive surveillance only. Conversely, in evaluable cases with positive GM tests and a clinical suspicion of invasive fungal disease, the performance of diagnostic-driven GM tests improved, with a positive predictive value of 89.6%.Conclusions. The low pretest risk of invasive aspergillosis in the context of effective antimold prophylaxis renders serum GM surveillance of asymptomatic patients unreliable, as all results would be either negative or false positive. The test remains useful to diagnose patients with a clinical suspicion of invasive fungal disease, calling for a more efficient copositioning of effective prophylaxis and GM testing in this clinical setting.