A prospective randomized controlled trial comparing PCR-based and empirical treatment with liposomal amphotericin B in patients after allo-SCT

Increased costs after allogeneic haematopoietic SCT are associated with major complications and re-transplantation

“…42 The poor prognosis of IFI in HSCT patients and ineffective diagnoses have necessitated the use of empirical treatment with expensive anti-fungals. [42][43][44][45] In the univariate analysis, death during the first year was associated with increased costs (P ¼ 0.02). The reason for this is probably that there is a high death rate in patients with major complications, such as severe acute GVHD, rejection and IFI.…”

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

“…63 Some clinical studies also suggest a possible role of PCR monitoring in guiding antifungal therapy. 61,62 Table 4 Overall pooled values, with 95% CI, of sensitivity, specificity and DOR of Mn, A-Mn and combined Mn/A-Mn testing Despite these encouraging results, PCRs are not considered in the revised EORTC/MSG consensus definitions for IFD. 1 The main reason is the lack of standardization, and thus of inter-laboratory reproducibility of the analyses.…”

“…60 When used as a screening test, authors favor the negative predictive value of the results. 61,62 For the diagnosis of IA using PCR in BAL fluids, another meta-analysis calculated a mean sensitivity of 79% (95% CI: 72.8-83.1) and a mean specificity of 94% (95% CI: 92.1-95.0). 63 Some clinical studies also suggest a possible role of PCR monitoring in guiding antifungal therapy.…”

Bacterial sepsis

“…In an observational study investigating implementation of multiplex PCR in the clinical routine of an ICU, an influence on treatment course was only observed when a pathogen was detected that was not susceptible to the initial calculated therapy-specifically, MDR (VRE and MRSA) bacteria and Candida species [94]. Only two randomized studies have been published on this topic so far: In one study comparing Aspergillus PCR to standard diagnostic testing in patients with fever and neutropenia, mortality could be significantly reduced by the PCR-directed treatment [95]. In another investigation conducted in an neonatal ICU in India, a significant survival advantage was conferred by multiplex PCR-based diagnostics compared to blood cultures [96].…”