A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients

Jordanides, N., Allan, E., McLintock, L., Copland, M., Devaney, M., Stewart, K., Parker, A., Johnson, P., Holyoake, T. and Jones, B. (2005) A prospective study of real-time panfungal PCR for the early diagnosis of invasive fungal infection in haemato-oncology patients. Bone Marrow Transplantation, 35(4), pp. 389-395. (doi: 10.1038/sj.bmt.1704768)

Abstract

A blinded prospective study was performed to determine whether screening of whole blood using a real-time, panfungal polymerase chain reaction (PCR) technique could predict the development of invasive fungal infection (IFI) in immunocompromised haemato-oncology patients. In all, 78 patients ( 125 treatment episodes) were screened twice weekly by real-time panfungal PCR using Light-Cycler(TM) technology. IFI was documented in 19 treatment episodes (five proven, three probable and 11 possible), and in 12, PCR was sequentially positive. PCR positivity occurred in: 4/5 proven; 2/3 probable; 6/11 possible; and 29/106 with no IFI. In 8/12 with IFI and sequentially positive PCR results, PCR positivity occurred before ( median 19.5 days) and in 4/12 ( median 10.5 days) after the initiation of empirical antifungal therapy. Based on sequential positive results for proven/probable IFI sensitivity, specificity, positive predictive value and negative predictive value were 75, 70, 15 and 98%, respectively. Real-time panfungal PCR is a sensitive tool for the early diagnosis of IFI in immunocompromised haemato-oncology patients. It may be most useful as a screening method in high-risk patients, either to direct early pre-emptive antifungal therapy or to determine when empirical antifungal therapy can be withheld in patients with antibiotic - resistant neutropenic fever. However, these strategies require further assessment in comparative clinical trials.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Holyoake, Professor Tessa and Copland, Professor Mhairi
• Authors: Jordanides, N., Allan, E., McLintock, L., Copland, M., Devaney, M., Stewart, K., Parker, A., Johnson, P., Holyoake, T., and Jones, B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: Bone Marrow Transplantation
• ISSN: 0268-3369