PMID- 25896093
OWN - NLM
STAT- MEDLINE
DCOM- 20160321
LR  - 20191210
IS  - 1532-2742 (Electronic)
IS  - 0163-4453 (Linking)
VI  - 71
IP  - 2
DP  - 2015 Aug
TI  - High negative predictive value diagnostic strategies for the reevaluation of 
      early antifungal treatment: A multicenter prospective trial in patients at risk 
      for invasive fungal infections.
PG  - 258-65
LID - S0163-4453(15)00098-5 [pii]
LID - 10.1016/j.jinf.2015.04.005 [doi]
AB  - Early antifungal therapeutic strategies are proposed during invasive fungal 
      infection (IFI), but antifungal stewardship programs should institute a 
      systematic reevaluation of prescriptions, particularly in the context of 
      empirical treatment. Here, we aimed to evaluate the performances and particularly 
      the negative predictive value (NPV) of diagnostic strategies, including a whole 
      blood panfungal quantitative PCR assay (PF-qPCR) in a high risk population for 
      IFI. The first step was to standardize and optimize a new PF-qPCR targeting ITS2 
      region. Then, this method was evaluated in a multicenter prospective study 
      including 313 patients with suspected IFI for whom an early antifungal treatment 
      was prescribed. All patients enrolled at day 0 of their treatment benefited from 
      serum Aspergillus galactomannan (GM) antigen detection twice a week, weekly 
      PF-qPCR assay, and when indicated and feasible, CT-scan and mycological sampling. 
      In total, 125 of 313 patients were diagnosed with IFI: 68 invasive aspergillosis 
      (eight proven, 48 probable and 12 possible), one fusariosis, 47 candidemia, three 
      disseminated candidiasis and six cryptococcosis. Globally, the sensitivity of the 
      PF-qPCR assay was only 40%, but the specificity, PPV and NPV were 96%, 88% and 
      69%, respectively. In the population of patients at high risk for invasive 
      aspergillosis who also benefited from Aspergillus GM detection, the sensitivity 
      and the NPV of the combined detection reached to 78% and 84%, respectively. Even 
      higher NPV were obtained when combining negative PF-qPCR and CT scan (95%) as 
      well as negative GM and CT scan (93%), thus allowing to rationalize and 
      re-evaluate the prescription of empirical treatment in such highly selected 
      population.
CI  - Copyright (c) 2015. Published by Elsevier Ltd.
FAU - Hasseine, Lilia
AU  - Hasseine L
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Nice, France. Electronic address: 
      Hasseine.l@chu-nice.fr.
FAU - Cassaing, Sophie
AU  - Cassaing S
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Toulouse, France.
FAU - Robert-Gangneux, Florence
AU  - Robert-Gangneux F
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Rennes, France.
FAU - Fillaux, Judith
AU  - Fillaux J
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Toulouse, France.
FAU - Marty, Pierre
AU  - Marty P
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Nice, Universite Nice Sophia 
      Antipolis, Unite Inserm U 1065, Equipe 6, France.
FAU - Gangneux, Jean-Pierre
AU  - Gangneux JP
AD  - Laboratoire de Parasitologie-Mycologie, CHU de Rennes, France.
CN  - PF-qPCR Study Group
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20150418
PL  - England
TA  - J Infect
JT  - The Journal of infection
JID - 7908424
RN  - 0 (DNA, Fungal)
RN  - 0 (DNA, Ribosomal Spacer)
SB  - IM
MH  - Adult
MH  - Blood/*microbiology
MH  - DNA, Fungal/genetics/isolation & purification
MH  - DNA, Ribosomal Spacer/genetics/isolation & purification
MH  - Drug Monitoring/*methods
MH  - Female
MH  - Fungemia/*diagnosis/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Molecular Diagnostic Techniques/*methods
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Real-Time Polymerase Chain Reaction/*methods
MH  - Secondary Prevention/*methods
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Antifungal stewardship program
OT  - Antifungals
OT  - Aspergillus galactomannan
OT  - Empirical treatment
OT  - Invasive aspergillosis
OT  - Invasive fungal infection
OT  - PCR
OT  - Panfungal PCR
OT  - Reevaluation
FIR - Sirvent, Anne
IR  - Sirvent A
FIR - Mondain, Veronique
IR  - Mondain V
FIR - Hyvernat, Herve
IR  - Hyvernat H
FIR - Rosenthal, Eric
IR  - Rosenthal E
FIR - Cointault, Olivier
IR  - Cointault O
FIR - Lavayssiere, Laurence
IR  - Lavayssiere L
FIR - Georges, Bernard
IR  - Georges B
FIR - Berry, Antoine
IR  - Berry A
FIR - de Guibert, Sophie
IR  - de Guibert S
FIR - Nimubona, Stanislas
IR  - Nimubona S
FIR - Revest, Matthieu
IR  - Revest M
FIR - Tattevin, Pierre
IR  - Tattevin P
EDAT- 2015/04/22 06:00
MHDA- 2016/03/22 06:00
CRDT- 2015/04/22 06:00
PHST- 2014/07/07 00:00 [received]
PHST- 2015/03/09 00:00 [revised]
PHST- 2015/04/10 00:00 [accepted]
PHST- 2015/04/22 06:00 [entrez]
PHST- 2015/04/22 06:00 [pubmed]
PHST- 2016/03/22 06:00 [medline]
AID - S0163-4453(15)00098-5 [pii]
AID - 10.1016/j.jinf.2015.04.005 [doi]
PST - ppublish
SO  - J Infect. 2015 Aug;71(2):258-65. doi: 10.1016/j.jinf.2015.04.005. Epub 2015 Apr 
      18.