Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Hardak, Emília; Yigla, Mordechai; Avivi, Irit; Fruchter, Oren; Sprecher, Hannah; Oren, Ilana

doi:10.1038/bmt.2009.65

Cited by 23 publications

(18 citation statements)

References 16 publications

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“…Similarly M Kousha et al, estimated the sensiyivity and specificity of PCR of BAL fluid to be 75-100% and 65-95% but for serum sample it was 70-80% and 65-85% only. 21,24 All these findings are in line with the results of our study. This shows the superiority of PCR over conventional methods.…”

Section: Discussionsupporting

confidence: 83%

“…Our results are consistent with previous studies in suggesting that PCR performed on BAL has high positive and negative predictive values. 21,24 The high negative predictive value of the PCR test reflects a low probability for fungal infection, hence a clinician can withhold the unjustified anti-fungal therapy in such cases, whereas a positive PCR result will lead to prompt and early administration of targeted antifungal treatment. E Hardak et al, found sensitivity of Candida PCR assay to be 95% as compared to Candida Elisa which showed a sensitivity of 75%.…”

Section: Discussionmentioning

confidence: 99%

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A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

2018

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Background: Incidence of Pulmonary Mycosis is rampantly growing in critically ill patients. This study was designed to comparatively evaluate conventional and molecular method-Polymerase Chain Reaction (PCR) for detecting Candida and Aspergillus species in Brocho-Alveolar Lavage (BAL) samples and secondarily to find out the Cost-Effective treatment for Pulmonary Mycosis.Methods: In this study 100 BAL-specimens were collected from patients suspected of Pulmonary Mycosis. These samples were examined for Aspergillus and Candida species by preparation of wet smear using potassium hydroxide, Gram staining, Culture media and Polymerase Chain Reaction (PCR). For Cost-Effectiveness analysis(CEA), a decision tree model was constructed for Anidulafungin and Fluconazole The probability of treatment success and mortality rate were extracted from published Randomized Control Trials. Incremental Cost Effectiveness Ratio (ICER) was calculated.Results: Out of 100 samples, 22 were found to be positive for mycotic infections, 9 were detected as Candida and 13 as Aspergillus. On comparing with KOH and Culture, it was observed that all KOH positive and all Culture positive fungal infections were PCR positive. In no cases PCR negative was identified either culture or KOH positive. This establishes the superiority of PCR over conventional diagnostic methods. Anidulafungin was associated with an Incremental Cost Effectiveness Ratio (ICER) of INR 1,13,217 per LY saved, which was below the implicit ICER threshold for India.Conclusions: PCR is a novel molecular method for early and definitive diagnosis of fungal infection and Aidulafungin appears to be the cost-effective drug for treatment of Pulmonary Mycosis.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

2018

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“…An increasing body of evidence is demonstrating the usefulness of such a genus-specific approach for neutropenic patients with hematological and nonhematological malignancies (92). A recent study documented significantly higher mortality rates (80% versus 35.6%; P ϭ 0.003) for patients with probable invasive pulmonary aspergillosis (IPA) according to traditional classification than for patients with IPA who had, in addition, a PCR-based diagnosis by use of bronchoalveolar lavage (BAL) fluid specimens (74). This advantage is probably related to earlier diagnosis with the NATbased approach (33) (5) concluded that a single PCR-negative result is sufficient to exclude possible or probable IA, whereas two positive tests are necessary to confirm the diagnosis (125).…”

Section: Nat-based Assays For Detection and Identification Ofmentioning

confidence: 99%

The Era of Molecular and Other Non-Culture-Based Methods in Diagnosis of Sepsis

et al. 2010

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SUMMARY Sepsis, a leading cause of morbidity and mortality throughout the world, is a clinical syndrome with signs and symptoms relating to an infectious event and the consequent important inflammatory response. From a clinical point of view, sepsis is a continuous process ranging from systemic inflammatory response syndrome (SIRS) to multiple-organ-dysfunction syndrome (MODS). Blood cultures are the current “gold standard” for diagnosis, and they are based on the detection of viable microorganisms present in blood. However, on some occasions, blood cultures have intrinsic limitations in terms of sensitivity and rapidity, and it is not expected that these drawbacks will be overcome by significant improvements in the near future. For these principal reasons, other approaches are therefore needed in association with blood culture to improve the overall diagnostic yield for septic patients. These considerations have represented the rationale for the development of highly sensitive and fast laboratory methods. This review addresses non-culture-based techniques for the diagnosis of sepsis, including molecular and other non-culture-based methods. In particular, the potential clinical role for the sensitive and rapid detection of bacterial and fungal DNA in the development of new diagnostic algorithms is discussed.

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“…BAL samples may not be ideal since they are very prone to contamination, as spores of Aspergillus are often present in the upper [20,21]. The study by Heng et al suggests that major clinical utility of GM and PCR in BAL would be to rule out a diagnosis if IPA if results were negative [22].…”

Section: Discussionmentioning

confidence: 99%

The Performance of Quantitative Real-Time Polymerase Chain Reaction and Galactomannan for Invasive Fungal Infections in Patients with Hematologic Malignancies

Hachem

Reitzel²,

Jiang³

et al. 2015

Fungal Genom Biol

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Impact of PCR-based diagnosis of invasive pulmonary aspergillosis on clinical outcome

Cited by 23 publications

References 16 publications

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

The Era of Molecular and Other Non-Culture-Based Methods in Diagnosis of Sepsis

The Performance of Quantitative Real-Time Polymerase Chain Reaction and Galactomannan for Invasive Fungal Infections in Patients with Hematologic Malignancies

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