真菌聚合酶链反应的诊断管理应用:结果阴性后对血浆和支气管肺泡灌洗液进行后续检测的低产率。

IF 8.2 1区 医学 Q1 IMMUNOLOGY Clinical Infectious Diseases Pub Date : 2024-10-15 DOI:10.1093/cid/ciae382
Tong Wang, Bosung Park, Gavin Anderson, Brian Shaller, Indre Budvytiene, Niaz Banaei
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引用次数: 0

摘要

背景:侵袭性真菌病的早期诊断对于优化治疗至关重要。虽然对血浆和支气管肺泡灌洗液(BAL)进行真菌聚合酶链反应(PCR)检测的临床实用性已得到证实,但后续检测的作用仍不明确:这是一项回顾性单中心研究。方法:这是一项回顾性的单中心研究,在阴性结果出现后的 1、2、3 和 4 周对血浆和/或 BAL 上的曲霉菌、粘菌、镰刀菌、头孢菌、二态真菌、肺孢子菌和念珠菌的 PCR 随访结果进行了测定:共对 264 名患者的 406 份血浆标本和 431 名患者的 983 份 BAL 标本进行了 1389 次跟踪检测。总体而言,血浆在 1、2、3 和 4 周的阳性率分别为 2.7% (4/148)、3.3% (4/123)、5.1% (4/78) 和 3.5% (2/57),BAL 的阳性率分别为 0% (0/333)、0.3% (1/288)、0.4% (1/228) 和 0.7% (1/134)。血浆中的曲霉菌、黏菌剂和镰刀菌 PCR 以及 BAL 中的曲霉菌和嗜肺曲霉菌 PCR 均可导致转阴。所有转阴患者均为免疫力低下者。在之前检测结果为阴性的 1 周内,血浆中有 2 例曲霉菌和 2 例粘菌 PCR 检测结果呈阳性,BAL 检测结果呈阳性的患者为零。在第 1 周,只有 1 种曲霉菌在第 7 天呈阳性,被归类为可能的真菌病:结论:在之前检测结果为阴性的 4 周内对血浆和 BAL 进行真菌 PCR 后续检测的结果较低,而且在第一周内很少出现具有临床意义的阳性结果。
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Application of Diagnostic Stewardship to Fungal Polymerase Chain Reaction: Low Yield of Follow-up Testing on Plasma and Bronchoalveolar Lavage After a Negative Result.

Background: Early diagnosis of invasive fungal disease is essential for optimizing management. Although the clinical utility of fungal polymerase chain reaction (PCR) testing on plasma and bronchoalveolar lavage (BAL) has been established, the role of follow-up testing remains unclear.

Methods: This was a retrospective single-center study. The yield of follow-up PCR for Aspergillus species, Mucorales agents, Fusarium species, Scedosporium species, dimorphic fungi, Pneumocystis jirovecii, and Candida species on plasma and/or BAL was measured at intervals of 1, 2, 3, and 4 weeks following a negative result.

Results: A total of 1389 follow-up tests on 406 plasma specimens from 264 patients and 983 BAL specimens from 431 patients were evaluated. Overall, the positivity rate at 1, 2, 3, and 4 weeks was 2.7% (4/148), 3.3% (4/123), 5.1% (4/78), and 3.5% (2/57), respectively, on plasma, and 0% (0/333), 0.3% (1/288), 0.4% (1/228), and 0.7% (1/134), respectively, on BAL. Conversions occurred with Aspergillus species, Mucorales agents, and Fusarium species PCR on plasma and Aspergillus species and P jirovecii PCR on BAL. All patients who converted were immunocompromised. Within 1 week of a prior negative test, 2 Aspergillus and 2 Mucorales PCRs were positive on plasma, and zero tests were positive on BAL. In week 1, only 1 Aspergillus species that was positive on day 7 was classified as probable fungal disease.

Conclusions: Fungal PCR follow-up testing on plasma and BAL within 4 weeks of a prior negative result was of low yield and rarely generated a positive result considered clinically significant in the first week.

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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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