Impact of posaconazole prophylaxis and antifungal treatment on BAL GM performance in hematology malignancy patients with febrile neutropenia: a real life experience

Background Diagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements...

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Published in:European journal of clinical microbiology & infectious diseases 2024, Vol.43 (1), p.33-43
Main Authors: Acet-Öztürk, Nilüfer Aylin, Ömer-Topçu, Dilara, Vurat Acar, Kübra, Aydın-Güçlü, Özge, Pınar, İbrahim Ethem, Demirdöğen, Ezgi, Görek-Dilektaşlı, Aslı, Kazak, Esra, Özkocaman, Vildan, Ursavas, Ahmet, Özkalemkaş, Fahir, Ener, Beyza, Ali, Rıdvan, Akalın, Halis
Format: Article
Language:English
Subjects:
Accuracy
Alveoli
Antifungal Agents - therapeutic use
Biomedical and Life Sciences
Biomedicine
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid - microbiology
Bronchoscopy
Bronchus
Diagnostic systems
Disease prevention
Febrile Neutropenia - drug therapy
Febrile Neutropenia - prevention & control
Fungicides
Hematologic Neoplasms - complications
Hematology
Humans
Internal Medicine
Invasive Pulmonary Aspergillosis - diagnosis
Invasive Pulmonary Aspergillosis - drug therapy
Invasive Pulmonary Aspergillosis - prevention & control
Lavage
Malignancy
Mannans - analysis
Medical Microbiology
Neoplasms
Neutropenia
Original Article
Population studies
Posaconazole
Prophylaxis
Retrospective Studies
Sensitivity and Specificity
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Summary:Background Diagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements in bronchoalveolar lavage (BAL), bronchial lavage (BL), and serum in hematological malignancy population. Methods Patients hospitalized in a single tertiary care center with hematologic malignancies undergoing fiberoptic bronchoscopy (FOB) with a preliminary diagnosis of IPA were retrospectively included. Results In all the study population ( n  = 327), AUC for BAL, BL, and serum GM were as follows: 0.731 [0.666–0.790], 0.869 [0.816–0.912], and 0.610 [0.540–0.676] with BL samples having the best diagnostic value. GM measurements in patients under posaconazole prophylaxis ( n  = 114) showed similar diagnostic performance. While specificity was similar between patients with and without posaconazole prophylaxis, sensitivity of GM measurements was lower in patients with prophylaxis. Analyses with patient classified according to antifungal treatment at the time of FOB procedure ( n  = 166) showed a decreased diagnostic accuracy in serum GM and BAL GM measurements related with the duration of treatment. However, BAL, BL, and serum GM measurements presented similar sensitivity and specificity in higher cut-off values in longer durations of antifungal treatment. Conclusion Our study shows that posaconazole prophylaxis and active short-term (3 days) antifungal treatment do not significantly affect overall diagnostic performance of GM measurements in bronchoalveolar lavage and bronchial lavage samples. However, using different cut-off values for patients receiving active treatment might be suggested to increase sensitivity.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-023-04686-7