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<publisher>HAL CCSD</publisher>
<title lang=en>High negative predictive value diagnostic strategies for the reevaluation of early antifungal treatment: A multicenter prospective trial in patients at risk for invasive fungal infections</title>
<creator>Hasseine, Lilia</creator>
<creator>Cassaing, Sophie</creator>
<creator>Robert-Gangneux, Florence</creator>
<creator>Fillaux, Judith</creator>
<creator>Marty, Pierre</creator>
<creator>Gangneux, Jean-Pierre</creator>
<contributor>Service de Parasitologie et Mycologie ; CHU Toulouse [Toulouse] - Hôpital Purpan - Institut Fédératif de Biologie (IFB)</contributor>
<contributor>Service de Parasitologie-Mycologie [Rennes] ; Université de Rennes 1 (UR1) - Hôpital Pontchaillou - CHU Pontchaillou [Rennes]</contributor>
<contributor>Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )</contributor>
<contributor>Centre méditérannéen de médecine moléculaire (C3M) ; Université Nice Sophia Antipolis (UNS) ; Université Côte d'Azur (UCA) - Université Côte d'Azur (UCA) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Service de Parasitologie-Mycologie ; Centre Hospitalier Universitaire de Nice ; CHU Nice - CHU Nice</contributor>
<description>International audience</description>
<source>The Journal of Infection</source>
<identifier>hal-01146845</identifier>
<identifier>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146845</identifier>
<source>https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146845</source>
<source>The Journal of Infection, 2015, 71 (2), pp.258-265. 〈10.1016/j.jinf.2015.04.005〉</source>
<identifier>DOI : 10.1016/j.jinf.2015.04.005</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.1016/j.jinf.2015.04.005</relation>
<identifier>PUBMED : 25896093</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/25896093</relation>
<language>en</language>
<subject>[SDV] Life Sciences [q-bio]</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>Early antifungal therapeutic strategies are proposed during invasive fungal infection (IFI), but antifungal stewardship programs should institute a systematic reevaluation of prescriptions, particularly in the context of empirical treatment. Here, we aimed to evaluate the performances and particularly the negative predictive value (NPV) of diagnostic strategies, including a whole blood panfungal quantitative PCR assay (PF-qPCR) in a high risk population for IFI. The first step was to standardize and optimize a new PF- rtPCR targeting ITS2 region. Then, this method was evaluated in a multicenter prospective study including 313 patients with suspected IFI for whom an early antifungal treatment was prescribed. All patients enrolled at day 0 of their treatment benefited from serum Aspergillus galactomannan (GM) antigen detection twice a week, weekly PF-qPCR assay, and when indicated and feasible, CT-scan and mycological sampling. In total, 125 of 313 patients were diagnosed with IFI: 68 invasive aspergillosis (eight proven, 48 probable and 12 possible), one fusariosis, 47 candidemia, three disseminated candidiasis and six cryptococcosis. Globally, the sensitivity of the PF-qPCR assay was only 40%, but the specificity, PPV and NPV were 96%, 88% and 69%, respectively. In the population of patients at high risk for invasive aspergillosis who also benefited from Aspergillus GM detection, the sensitivity and the NPV of the combined detection reached to 78% and 84%, respectively. Even higher NPV were obtained when combining negative PF-qPCR and CT scan (95%) as well as negative GM and CT scan (93%), thus allowing to rationalize and re-evaluate the prescription of empirical treatment in such highly selected population.</description>
<date>2015</date>
</dc>
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