Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience

Anthony W. Martinelli; Callum B. Wright; Marta S. Lopes; Rosemary L. Swayne; Pramila Krishnamurthy; Charles Crawley; Ben Uttenthal; George Follows; Judith Babar; Sani H. Aliyu; David A. Enoch; Clare R. Sander

doi:10.1099/jmm.0.001564

Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience

Anthony W. Martinelli^*, Callum B. Wright, Marta S. Lopes, Rosemary L. Swayne, Pramila Krishnamurthy, Charles Crawley, Ben Uttenthal, George Follows, Judith Babar, Sani H. Aliyu, David A. Enoch, Clare R. Sander

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Hypothesis/Gap Statement. The impacts of increased biomarker testing on antifungal prescribing have not yet been fully examined in a real-life setting. Objectives. Biomarkers for invasive fungal disease (IFD) have been shown to reduce antifungal prescriptions in neutropaenic haemato-oncology patients. Our study aimed to assess the real-life impacts of introducing a novel biomarker-based pathway, incorporating serum galactomannan and Aspergillus PCR, for pyrexial haemato-oncology admissions. Methods. Patients with neutropaenic fever were identified prospectively after introduction of the new pathway from 2013-2015. A historical group of neutropaenic patients who had blood cultures taken from 2009-2012 was generated for comparison. Clinical details, including demographics, underlying diagnosis, investigations, radiology and antimicrobial treatment were obtained. Results. Prospective data from 308 patients were compared to retrospective data from 302 patients. The proportion of patients prescribed an antifungal medication was unchanged by the pathway (P=0.79), but the pattern was different, with more patients receiving targeted antifungals (P=0.04). A negative serum galactomannan test was not sufficient evidence to withhold therapy, with 17.2% of these episodes felt to have possible or probable IFD using the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. There was no difference in 30-day mortality (P=0.21) or 1-year mortality (P=0.57) following introduction of the pathway. Conclusions. Biomarkers can be used safely as part of a multidisciplinary approach to the diagnosis of IFD in neutropaenic haemato-oncology patients. Whilst they do not necessarily result in antifungal therapy being withheld, they can allow more confident diagnosis of IFD and more specific antifungal therapy in selected cases.

Original language	English
Article number	001564
Journal	Journal of Medical Microbiology
Volume	71
Issue number	7
DOIs	https://doi.org/10.1099/jmm.0.001564
Publication status	Published - 2022
Externally published	Yes

Bibliographical note

Funding Information:
5. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of

Funding Information:
This study was funded by Pfizer and Gilead.

Funding Information:
A.W.M. is supported by the Wellcome Trust. D.A.E. has received funding from MSD, Astellas, Gilead and Pfizer – none of these are related to this submission.

Publisher Copyright:
© 2022 The Authors.

Keywords

antifungal agents
aspergillosis
biomarkers
fungal infection
galactomannan

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1099/jmm.0.001564

Cite this

Martinelli, A. W., Wright, C. B., Lopes, M. S., Swayne, R. L., Krishnamurthy, P., Crawley, C., Uttenthal, B., Follows, G., Babar, J., Aliyu, S. H., Enoch, D. A., & Sander, C. R. (2022). Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience. Journal of Medical Microbiology, 71(7), Article 001564. https://doi.org/10.1099/jmm.0.001564

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title = "Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience",

abstract = "Hypothesis/Gap Statement. The impacts of increased biomarker testing on antifungal prescribing have not yet been fully examined in a real-life setting. Objectives. Biomarkers for invasive fungal disease (IFD) have been shown to reduce antifungal prescriptions in neutropaenic haemato-oncology patients. Our study aimed to assess the real-life impacts of introducing a novel biomarker-based pathway, incorporating serum galactomannan and Aspergillus PCR, for pyrexial haemato-oncology admissions. Methods. Patients with neutropaenic fever were identified prospectively after introduction of the new pathway from 2013-2015. A historical group of neutropaenic patients who had blood cultures taken from 2009-2012 was generated for comparison. Clinical details, including demographics, underlying diagnosis, investigations, radiology and antimicrobial treatment were obtained. Results. Prospective data from 308 patients were compared to retrospective data from 302 patients. The proportion of patients prescribed an antifungal medication was unchanged by the pathway (P=0.79), but the pattern was different, with more patients receiving targeted antifungals (P=0.04). A negative serum galactomannan test was not sufficient evidence to withhold therapy, with 17.2% of these episodes felt to have possible or probable IFD using the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. There was no difference in 30-day mortality (P=0.21) or 1-year mortality (P=0.57) following introduction of the pathway. Conclusions. Biomarkers can be used safely as part of a multidisciplinary approach to the diagnosis of IFD in neutropaenic haemato-oncology patients. Whilst they do not necessarily result in antifungal therapy being withheld, they can allow more confident diagnosis of IFD and more specific antifungal therapy in selected cases.",

keywords = "antifungal agents, aspergillosis, biomarkers, fungal infection, galactomannan",

author = "Martinelli, {Anthony W.} and Wright, {Callum B.} and Lopes, {Marta S.} and Swayne, {Rosemary L.} and Pramila Krishnamurthy and Charles Crawley and Ben Uttenthal and George Follows and Judith Babar and Aliyu, {Sani H.} and Enoch, {David A.} and Sander, {Clare R.}",

note = "Funding Information: 5. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Funding Information: This study was funded by Pfizer and Gilead. Funding Information: A.W.M. is supported by the Wellcome Trust. D.A.E. has received funding from MSD, Astellas, Gilead and Pfizer – none of these are related to this submission. Publisher Copyright: {\textcopyright} 2022 The Authors.",

year = "2022",

doi = "10.1099/jmm.0.001564",

language = "English",

volume = "71",

journal = "Journal of Medical Microbiology",

issn = "0022-2615",

publisher = "Microbiology Society",

number = "7",

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T1 - Introducing biomarkers for invasive fungal disease in haemato-oncology patients

T2 - a single-centre experience

AU - Martinelli, Anthony W.

AU - Wright, Callum B.

AU - Lopes, Marta S.

AU - Swayne, Rosemary L.

AU - Krishnamurthy, Pramila

AU - Crawley, Charles

AU - Uttenthal, Ben

AU - Follows, George

AU - Babar, Judith

AU - Aliyu, Sani H.

AU - Enoch, David A.

AU - Sander, Clare R.

N1 - Funding Information: 5. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Funding Information: This study was funded by Pfizer and Gilead. Funding Information: A.W.M. is supported by the Wellcome Trust. D.A.E. has received funding from MSD, Astellas, Gilead and Pfizer – none of these are related to this submission. Publisher Copyright: © 2022 The Authors.

PY - 2022

Y1 - 2022

N2 - Hypothesis/Gap Statement. The impacts of increased biomarker testing on antifungal prescribing have not yet been fully examined in a real-life setting. Objectives. Biomarkers for invasive fungal disease (IFD) have been shown to reduce antifungal prescriptions in neutropaenic haemato-oncology patients. Our study aimed to assess the real-life impacts of introducing a novel biomarker-based pathway, incorporating serum galactomannan and Aspergillus PCR, for pyrexial haemato-oncology admissions. Methods. Patients with neutropaenic fever were identified prospectively after introduction of the new pathway from 2013-2015. A historical group of neutropaenic patients who had blood cultures taken from 2009-2012 was generated for comparison. Clinical details, including demographics, underlying diagnosis, investigations, radiology and antimicrobial treatment were obtained. Results. Prospective data from 308 patients were compared to retrospective data from 302 patients. The proportion of patients prescribed an antifungal medication was unchanged by the pathway (P=0.79), but the pattern was different, with more patients receiving targeted antifungals (P=0.04). A negative serum galactomannan test was not sufficient evidence to withhold therapy, with 17.2% of these episodes felt to have possible or probable IFD using the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. There was no difference in 30-day mortality (P=0.21) or 1-year mortality (P=0.57) following introduction of the pathway. Conclusions. Biomarkers can be used safely as part of a multidisciplinary approach to the diagnosis of IFD in neutropaenic haemato-oncology patients. Whilst they do not necessarily result in antifungal therapy being withheld, they can allow more confident diagnosis of IFD and more specific antifungal therapy in selected cases.

AB - Hypothesis/Gap Statement. The impacts of increased biomarker testing on antifungal prescribing have not yet been fully examined in a real-life setting. Objectives. Biomarkers for invasive fungal disease (IFD) have been shown to reduce antifungal prescriptions in neutropaenic haemato-oncology patients. Our study aimed to assess the real-life impacts of introducing a novel biomarker-based pathway, incorporating serum galactomannan and Aspergillus PCR, for pyrexial haemato-oncology admissions. Methods. Patients with neutropaenic fever were identified prospectively after introduction of the new pathway from 2013-2015. A historical group of neutropaenic patients who had blood cultures taken from 2009-2012 was generated for comparison. Clinical details, including demographics, underlying diagnosis, investigations, radiology and antimicrobial treatment were obtained. Results. Prospective data from 308 patients were compared to retrospective data from 302 patients. The proportion of patients prescribed an antifungal medication was unchanged by the pathway (P=0.79), but the pattern was different, with more patients receiving targeted antifungals (P=0.04). A negative serum galactomannan test was not sufficient evidence to withhold therapy, with 17.2% of these episodes felt to have possible or probable IFD using the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. There was no difference in 30-day mortality (P=0.21) or 1-year mortality (P=0.57) following introduction of the pathway. Conclusions. Biomarkers can be used safely as part of a multidisciplinary approach to the diagnosis of IFD in neutropaenic haemato-oncology patients. Whilst they do not necessarily result in antifungal therapy being withheld, they can allow more confident diagnosis of IFD and more specific antifungal therapy in selected cases.

KW - antifungal agents

KW - aspergillosis

KW - biomarkers

KW - fungal infection

KW - galactomannan

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DO - 10.1099/jmm.0.001564

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ER -

Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience

Abstract

Bibliographical note

Keywords

UN SDGs

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