Systematic Review and Meta-Analysis of Detecting Galactomannan in Bronchoalveolar Lavage Fluid for Diagnosing Invasive Aspergillosis

Zou, Ming-Xiang; Tang, Lanhua; Zhao, Shushan; Zhao, Zijin; Chen, Luyao; Chen, Peng; Huang, Zebing; Li, Jun; Chen, Lizhang; Fan, Xue‐Gong

doi:10.1371/journal.pone.0043347

Cited by 192 publications

(145 citation statements)

References 69 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…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

“…D'Haese ve arkadaşları 25 tarafından yapılan çalışmada, nötropenik ve nötropenik olmayan İPA olgularında optimal GM değeri ≥ 0.8 olarak saptanmıştır. Zou ve arkadaşları 24 tarafından yapılan meta-analizde ise, İPA için optimal GM değeri ≥ 1.0 olarak bildirilmiştir. Çalışma-mızda, BAL GM antijeninin, serum GM antijenine göre İPA tanı değerinin yüksek olduğu belirlenmiştir.…”

Section: İstatistiksel Analizunclassified

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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

show abstract

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

View full text Add to dashboard Cite

show abstract

“…[11] We did the diagnostic evaluation of GM assay at different cut off values for both single and consecutive samples. Some authors suggest the use of ≥ 0.7 as cut off in single serum samples.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

RJLBPCS

View full text Add to dashboard Cite

Introduction: Invasive Aspergillosis (IA) can cause significant morbidity and mortality in pediatric cancer patients. The Galactomannan enzyme immunoassay (GM-EIA) has shown promising results to diagnose IA in adult patients. But data on this assay in children are limited by small sample size and conflicting results. We evaluated GM-EIA at different cut off in pediatric cancer patients on chemotherapy with fever and neutropenia and not responding to broad spectrum antibiotics for four days. Aim: To Evaluate Galactomannan at different cut off values in 200 pediatric cancer patients. Materials and Methods: It is a hospital based cross sectional cohort study in pediatric cancer patients. Serum specimens were collected either once or twice weekly, during neutropenic periods. Operating characteristics were calculated using the GM-EIA index values (IV) of 0.5, 0.7. 1.0 & 1.5 in serum samples. Results: 232 serum samples from 200 febrile neutropenic patients were available for evaluation. Of these 232 samples 168 samples were single samples and 32 were consecutive samples (received twice in a week). GM assay was evaluated in both single and consecutive samples at different cut off IV. For single sample the best cut off IV was found to be 1.5 IV. Sensitivity, specificity, PPV, NPV, PLR and NLR at 1. 5 IV were: 78, 86, 79, 83, 4.83, and 0.20 respectively. For consecutive samples the best cut off IV was found to be 0.5 at which the sensitivity, specificity, PPV, NPV, PLR and NLR were: 84.2, 86.46, 83.73, 85.50,5.82 and 0.18 respectively. Conclusion:Role of single sample cannot be ruled out in establishing the diagnosis of IA in pediatric cancer patients especially in resource poor settings where frequent sampling is not possible. The best cut off IV of GM for diagnosis of IA in pediatric cancer patients in single serum sample is 1.5 and in consecutive sample is 0.5. MATERIALS AND METHODSThe study collection and stored at -20°C until analysis.2-3 ml of blood were collected in pediatric biphasic blood culture bottle prior to the administration of antimicrobials and were incubated aerobically at 37˚C and checked every day up to 7 days and then twice a week for up to 4 weeks, unless evidence of microbial growth was observed, subculture was done on Sabouraud's dextrose agar (SDA) plates, and incubated at 37°C and 25°C. The blood cultures were considered as negative after four weeks of incubation.[10]. GM levels in serum was measured by using Platelia Aspergillus enzyme immunoassay test (Bio Rad, Platelia, Marnes, La Coquette, France) as per the manufacturer instructions. Results were recorded as indexes relative to the mean OD of the threshold controls. Samples that had GM IV of ≥ 0.5 were considered as positive. Second samples of the patients were considered as independent episode if it was received after 4 week apart from the previous one, with the patient becoming clinically well between this duration. All these samples were also evaluated at 0.7, 1.0 and 1.5 IV.Decision for the start of antifungal prophylaxis...

show abstract

“…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%

“…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. 73,74 There are no data to support the use of BDG testing in BAL.…”

Section: Improving Diagnosis Of Invasive Aspergillosismentioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

View full text Add to dashboard Cite

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.

show abstract

Systematic Review and Meta-Analysis of Detecting Galactomannan in Bronchoalveolar Lavage Fluid for Diagnosing Invasive Aspergillosis

Cited by 192 publications

References 69 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

Untitled

Antifungal stewardship considerations for adults and pediatrics

Contact Info

Product

Resources

About