Galactomannan and Polymerase Chain Reaction-Based Screening for Invasive Aspergillosis Among High-Risk Hematology Patients: A Diagnostic Meta-analysis.

Abstract

BACKGROUND:

Screening of high-risk patients for invasive aspergillosis (IA) has the potential to decrease the use of empiric antifungal agents. However, the performance of different screening methods has not been studied.

METHODS:

We performed a meta-analysis of published studies to assess the diagnostic performance of galactomannan (GM) and polymerase chain reaction (PCR) as weekly screening tests in high-risk populations. The sensitivity and specificity of 6 approaches combining GM and PCR were estimated using the bivariate model.

RESULTS:

Thirteen studies with 1670 patients met our inclusion criteria. Single positive test results had modest sensitivity and specificity for screening (respectively, 92% and 90% for GM; 84% and 76% for PCR). The screening approach with the highest sensitivity was the one that used at least 1 GM- or PCR-positive result to define a positive episode, achieving a sensitivity of 99%, significantly higher than any single test (P = .0018 compared with GM and P < .0001 compared with PCR). Meanwhile, when both GM and PCR were positive for the same patient, the specificity increased to 98%, which was not significantly different compared to the specificity of at least 2 positive GM (95%, P = .56 for the comparison) or PCR results (93%, P = .07 for the comparison).

CONCLUSIONS:

When screening high-risk patients for IA with GM and PCR tests, the absence of any positive test can obviate the need for antifungal agents with a negative predictive value of 100%, whereas the presence of at least 2 positive results is highly suggestive of an active infection with a positive predictive value of 88%.

• Authors: Marios Arvanitis, Theodora Anagnostou, Eleftherios Mylonakis
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 61 Issue 8 Pg. 1263-72 (Oct 15 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 26157047 (Publication Type: Journal Article, Meta-Analysis)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• DNA, Fungal
• Mannans
• galactomannan
• Galactose

Topics

• Aspergillosis (diagnosis, microbiology)
• Aspergillus (genetics, isolation & purification)
• DNA, Fungal (analysis)
• Enzyme-Linked Immunosorbent Assay (methods)
• Galactose (analogs & derivatives)
• Humans
• Mannans (analysis)
• Mass Screening (statistics & numerical data)
• Polymerase Chain Reaction
• Risk Factors
• Sensitivity and Specificity