Accuracy of BAL Galactomannan in Diagnosing Invasive Aspergillosis

Guo, Yaling; Chen, Yiqiang; Wang, Ke; Qin, Simeng; Wu, Cong; Kong, Jinliang

doi:10.1378/chest.10-0488

Cited by 182 publications

(124 citation statements)

References 40 publications

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“…Bu durum, testin, fungal yükün fazla olduğu primer enfeksiyon bölgesinde çalı-şılmasından kaynaklanmaktadır 23,24 . Ancak, serum GM antijeninin aksine, BAL sıvısında GM antijeninin pozitif sınır değeri konusunda görüş birliği bulunmamaktadır.…”

Section: İstatistiksel Analizunclassified

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Özger¹,

Hızel²,

Kalkancı³

et al. 2015

Mikrobiyol Bul

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ÖZNötropenik olmayan yoğun bakım (YB) hastaları, invazif pulmoner aspergilloz (İPA) gelişimi için artmış risk taşımaktadır. Bu olgularda, tanı için kullanılabilecek radyolojik ve mikrobiyolojik yöntemlerin (direkt mikroskopi, kültür) duyarlılık ve özgüllükleri oldukça düşüktür. Bu çalışmada, nötropenik olmayan YB hastalarında İPA risk faktörlerinin değerlendirilmesi, galaktomannan (GM) antijen ve Aspergillus nükleik asit tespiti yöntemlerinin, İPA için tanısal değerinin belirlenmesi amaçlanmıştır. Çalışmaya, OcakAralık 2013 tarihleri arasında, göğüs hastalıkları YB ünitesinde invazif mekanik ventilasyon (İMV) ile takip edilen ve bronkoskopi uygulanan 44 hasta (13 kadın, 31 erkek; yaş aralığı: 36-96 yıl) dahil edilmiştir. Geliş Tarihi

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Section: İstatistiksel Analizunclassified

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Özger¹,

Hızel²,

Kalkancı³

et al. 2015

Mikrobiyol Bul

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“…8 Routine diagnostic measures such as smear and culture for fungi, radiology, and clinical symptoms have low sensitivity and specificity. [9][10][11] Obtaining tissue samples is difficult owing to the condition of the patients as well as the risk of bleeding. Therefore, rapid tests (such as antigen detection) are promising options.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Tabarsi

Soraghi²,

Marjani³

et al. 2012

Exp Clin Transplant

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Objectives: This study sought to compare the sensitivities of serum galactomannan and bronchoalveolar lavage galactomannan in diagnosing invasive aspergillosis in solid-organ transplant recipients (lung and heart). Materials and Methods: This study took place in the lung transplant center of the National Research Institute for Tuberculosis and Lung Disease. All patients with clinical and radiologic manifestations suggestive of pulmonary infection were included. Serum and bronchoalveolar lavage galactomannan were measured. Results: Seventeen patients were included (lung, 15; heart, 1; heart-lung, 1). Probable or definite invasive aspergillosis was diagnosed in 9 patients. With a cutoff ≥ 0.5, serum galactomannan sensitivity and specificity for diagnosing invasive aspergillosis were 77.18% and 100%. Negative predictive value and positive predictive value were 80% and 100%. The sensitivity and specificity of bronchoalveolar lavage galactomannan for diagnosing invasive aspergillosis with cutoff of ≥ 0.5 was 100%. Conclusions: Regarding the high levels of mortality and problems in diagnosing this disease, using bronchoalveolar lavage galactomannan could be a suitable option.

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“…63 The overall sensitivity and specificity of bronchoalveolar lavage (BAL) GM has been reported to be 85% and 90%-95%, respectively. 71,72 While data for BAL GM suggest that a higher optical density (OD) cut-off (1.0 vs 0.5) increases specificity, the FDA considers an OD index of at least 0.5 to be positive. 72 In contrast to the serum assay, BAL GM seems to perform well in SOT recipients.…”

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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Accuracy of BAL Galactomannan in Diagnosing Invasive Aspergillosis

Cited by 182 publications

References 40 publications

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Comparison of Serum and Bronchoalveolar Lavage Galactomannan in Diagnosing Invasive Aspergillosis in Solid-Organ Transplant Recipients

Antifungal stewardship considerations for adults and pediatrics

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