2055. Utility of Aspergillus Galactomannan Assay in Allogeneic Stem Cell Transplant Recipients
Session: Poster Abstract Session: Diagnostics: Mycology
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Taplitz-etal-IDWeek-Posterfinal2055-%2820181003%29 (2).pdf (2.5 MB)
  • Background:

    Allogeneic hematopoietic stem cell transplantation (HSCT) is a valuable treatment option for patients with some blood/malignant disorders. However, this procedure may be complicated by life-threatening infections, including invasive aspergillosis (IA). Diagnosis of IA is challenging due to nonspecific symptoms that present similar to other infections; and delays in initiation of treatment are associated with poor outcomes. The galactomannan assay (GM) is a widely used test for the early diagnosis of IA and allows for prompt initiation of antifungal therapy. However, a positive (+) GM result requires further workup for a definitive diagnosis. Furthermore, false positives can lead to unnecessary treatment with expensive and potentially toxic antifungal medications. At UC San Diego Health, allogeneic HSCT patients not on mold-active agents for antifungal prophylaxis have GM tested weekly until 100 days post-HSCT. This study aims to describe the utility of routine GM assays in this HSCT population.

    Methods:

    This is a retrospective single-center study of patients > 18 years of age post-allogeneic HSCT at UC San Diego Health from January 2015 - December 2016 with GM results reported in the electronic medical record. Data includes patient demographics, GM results up to 100 days post-HSCT, antifungal prophylaxis, further testing performed, diagnosis of possible, probable and proven IA, and outcome of infection.

    Results:

    In total, 108 patients met criteria for enrollment in this study. There were a total of 1354 GM results, of which only 2.8% (38) were positive (> = 1 +GM) in 25 patients (23% of all patients). Of these, 20 of 25 (80%) were found to be false positives. In total, 7 of 108 patients had a diagnosis of possible or probable IA. Of the seven, 2 had 0 +GM, and 2 had 1 +GM. In the 2 with 1+GM, IA diagnosis was notably made prior to the +GM result. In only 3 of the 7 cases did +GM screening lead to diagnosis of IA; of these, 2 patients had acute GVHD and 1 developed infection during neutropenia, in the first 2 weeks post-HSCT.

    Conclusion:

    Routine GM testing adds to cost and is not a useful predictor of IA infection in the studied population. Studies to determine what populations, if any, would most benefit from routine pre-emptive GM or other fungal screening are needed.

    Sabeen Dagher, PharmD1, Katherine Medley, PharmD2, Nina Haste, PharmD, PhD2 and Randy Taplitz, MD3, (1)University of CA, San Diego, La Jolla, CA, (2)Pharmacy, University of California, San Diego, San Diego, CA, (3)Division of Infectious Diseases, University of California San Diego Health Centers, San Diego, CA

    Disclosures:

    S. Dagher, None

    K. Medley, None

    N. Haste, None

    R. Taplitz, U.C.S.D.: Scientific Advisor , Consulting fee .

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