2047. Study of Molecular epidemiology, risk factor analysis and comparison of diagnostic methods for rapid diagnosis of fungal pneumonia in critically ill cirrhotics
Session: Poster Abstract Session: Diagnostics: Mycology
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • ID WEEK POSTER.pdf (290.3 kB)
  • <span;>Background:
    <span;>Liver cirrhosis causes immune dysregulation and increased susceptibility to fungal infections. We studiede risk factors, molecular epidemiology and compared the rapid diagnostic methods and biomarkers for fungal pneumonia in critically ill cirrhotics
    <span;>Methods:
    <span;>Single-center, prospective cohort study of 50 critically ill cirrhotics with fungal pneumonia between Jan-Sept2017. Comparative analysis of culture, real time PCR and biomarkers; Bronchoalveolar lavage and serum galactomannan, serum procalcitonin were measured by ELISA and chemiluminescence assay on day 1, 3,7. Final outcome were mortality within 1 month after diagnosis or discharge. Genotyping of clinical and air sampling Aspergillus isolates was done
    <span;>Results: Aspergillus flavus was most common species (34/50,68%). Risk factors were, neutropenia (p 0.03), steroids prior to ICU admission (p 0.02), prolonged hospitalizations >21 days (p 0.05). Culture positivity was 80%. Culture was not inferior to real time PCR for diagnosis of fungal pneumonia. BAL Galactomannan was early prognostic marker with median rise above >1 index value on day 1. Median PCT level was higher from day 1in the fungal pneumonia non-survivor group (3.29 vs. 0.8ng/ml) with higher 30-day mortality (72%). Higher PCT was associated with bacterial co-infection (48%), antibiotic(74%) and antifungal therapy and renal failure and mortality. Cinical isolates from patients matched those recovered from air in 2 clusters
    <span;>Conclusion:
    <span;>Fungal pneumonia complicates cirrhotics with neutropenia, prolonged hospitalization and steroids as risk factors. Aspergillus species predominate as in Asian epidemiology. Culture methods are reliable and combination of molecular test with BAL galactomannan is useful for rapid diagnosis. SerumPCT is raised in patients with fungal pneumonia and associated with higher mortality. In our study the baseline PCT at admission to ICU was higher in non- survivor group, levels on D3 and D7 were persistantly higher. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in fungal pneumonia. Genetic relatedness of clinical and environmental sample necessitates infection control measures to prevent invasive aspergillosis in high-risk patients.
    Pratibha Ramchandra Kale, MD DNB MNAMS, Clinical Microbiology, Institute of Liver and Biliary Sciences, NEW DELHI, India, Vikas Khillan, MD, Clinical Microbiology, Institute of liver and biliary sciences, New Delhi, India and Shivkumar Sarin, MD DM, Hepatology, Institute of liver and biliary sciences, New Delhi, India

    Disclosures:

    P. R. Kale, None

    V. Khillan, None

    S. Sarin, None

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