1563. Galactomannan Testing and Aspergillus PCR in Same-Day Bronchoalveolar Lavage and Blood Samples for Diagnosis of Invasive Mould Infections
Session: Poster Abstract Session: Mycology: Diagnostic
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster IDWeek 2016sk-upload.pdf (856.8 kB)
  • Background: In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive pulmonary aspergillosis (IPA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e. primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate.


    Methods: We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using bronchoalveolar lavage fluid samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IPA and 37 with no evidence of IPA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital). Patients with possible IPA were excluded from this analysis.


    Results: Results are displayed in the table. Best sensitivity (81%) for detecting proven/probable IPA was achieved when Aspergillus PCR, BAL-culture and serum-GM were combined (specificity 92%).


    Conclusion: While sensitivities of the evaluated diagnostic tests – when interpreted on their own - were low in BAL and even lower in blood, sensitivities improved markedly when diagnostic tests were combined.

    Table 1:Sensitivity (n=16), specificity (n=37), positive predictive value (PPV), negative predictive value (NPV) and diagnostic odds ratio (95% confidence interval) for Aspergillus PCR, GM (Cut-off: >0,5 optical density index) and culture for diagnosing probable/proven vs. no IPA (sample material stated in parenthesis)
    Test methods Sensitivity [%] Specificity [%] PPV [%] NPV [%] DOR
    PCR (BAL) 43 100 100 80 59.2 [3.1-1,1132]
    PCR (blood) 0 100 0 100 -
    GM (BAL) 38 92 67 77 6.8 [1.4-32.2]
    GM (serum) 31 100 100 77 38.9 [1,8-699.3]
    PCR (BAL) and/or GM (BAL) 69 92 79 87 24.9 [5.1-121.7]
    PCR (BAL) and/or GM (serum) 63 100 100 86 121.2 [6.3-2,332]
    Culture (BAL) 25 100 100 76 27.0 [1.4-537.9]
    PCR (BAL) and/or GM (BAL) and/or culture (BAL) 75 92 80 90 34 [6.6-174.5]
    PCR (BAL) and/or GM (serum) and/or culture (BAL 81 92 81 92 49.11 [8.8-275.3]


    Sven Heldt, MD1, Susanne Eigl, MD2, Dieter Buchheidt, MD3, Juergen Prattes, MD4, Robert Krause, MD4, Albert Woelfler, MD1, Florian Prueller, MD1, Birgit Spiess, PhD3, Martin Hoenigl, MD2 and Tobias Boch, MD3, (1)Medical University of Graz, Graz, Austria, (2)Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria, (3)Mannheim University Hospital, Mannheim, Germany, (4)Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria

    Disclosures:

    S. Heldt, None

    S. Eigl, None

    D. Buchheidt, None

    J. Prattes, None

    R. Krause, None

    A. Woelfler, None

    F. Prueller, None

    B. Spiess, None

    M. Hoenigl, Gilead: Funding Applicant , Grant Funding

    T. Boch, None

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