Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital
Invasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives: To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequenc...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867024000011 |
| _version_ | 1797279288490196992 |
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| author | Lucieni Oliveira Conterno Plínio Trabasso Mariângela Ribeiro Resende Paula Sanches Paschoali Leticia Bergamo Pascucci Maria Luiza Moretti |
| author_facet | Lucieni Oliveira Conterno Plínio Trabasso Mariângela Ribeiro Resende Paula Sanches Paschoali Leticia Bergamo Pascucci Maria Luiza Moretti |
| author_sort | Lucieni Oliveira Conterno |
| collection | DOAJ |
| description | Invasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives: To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequency, the factors associated with positive GM test, and the in-hospital mortality. Methods: We conducted a retrospective observational study including patients aged 18 or over with hematological malignancy or submitted to HSCT. GM test was measured twice weekly. The hypothesis of IFI was considered in patients with neutropenia and persistent fever despite broad-spectrum antibiotics. Results: A total of 496 patients were evaluated; the mean of GM tests performed per patient was 4.2 (+3.1), and 86 (17.3 %) had positive results. IFI was diagnosed in 166 (33.5 %) and IA in 22 (24.6 %) patients. Positive GM test was more frequent in patients with IFI (72.2 % and 25.1 %; OR 8.1; 95 % CI 4.8 - 13.8), and was associated with therapeutic antifungals prescription (52, 9 % and 20.5 %; OR 4.3, 95CI% 2.0 - 9.4), as well as lung abnormalities on HRCT (45.3% vs. 21.5 %; OR 3.0, 95 %CI 1.4 - 6.5). Mortality was 31.6 %. In the multivariate analysis, the variables associated with mortality were the hypothesis of IFI (OR 6.35; 95 % CI 3.63–11.12.0), lung abnormalities on HRCT (57.9 % and 26.9 %; OR 2 0.6; 95 % CI 1.5 – 4.4), and positive GM test (57.9 % and 26.9 %; OR 2.7 95 % CI 1.6 - 4.5). Conclusions: Positive GM test was associated with lung abnormalities on HRCT and with the introduction of therapeutic antifungals. If adequate anti-mold prophylaxis is available, the GM test should not be used as screening, but to investigate IFI in high-risk patients. The diagnosis of IFI, positive GM test and lung abnormalities on HRCT were predictors of hospital mortality in patients with hematological malignancies or undergoing HSCT. |
| first_indexed | 2024-03-07T16:23:07Z |
| format | Article |
| id | doaj.art-e0bfc82297284de7ad7fa1934704c86a |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-03-07T16:23:07Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-e0bfc82297284de7ad7fa1934704c86a2024-03-04T04:12:00ZengElsevierBrazilian Journal of Infectious Diseases1413-86702024-01-01281103718Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospitalLucieni Oliveira Conterno0Plínio Trabasso1Mariângela Ribeiro Resende2Paula Sanches Paschoali3Leticia Bergamo Pascucci4Maria Luiza Moretti5Corresponding author.; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilUniversidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Clínica Médica, Subdepartamento de Infectologia, Campinas, São Paulo, SP, BrazilInvasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives: To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequency, the factors associated with positive GM test, and the in-hospital mortality. Methods: We conducted a retrospective observational study including patients aged 18 or over with hematological malignancy or submitted to HSCT. GM test was measured twice weekly. The hypothesis of IFI was considered in patients with neutropenia and persistent fever despite broad-spectrum antibiotics. Results: A total of 496 patients were evaluated; the mean of GM tests performed per patient was 4.2 (+3.1), and 86 (17.3 %) had positive results. IFI was diagnosed in 166 (33.5 %) and IA in 22 (24.6 %) patients. Positive GM test was more frequent in patients with IFI (72.2 % and 25.1 %; OR 8.1; 95 % CI 4.8 - 13.8), and was associated with therapeutic antifungals prescription (52, 9 % and 20.5 %; OR 4.3, 95CI% 2.0 - 9.4), as well as lung abnormalities on HRCT (45.3% vs. 21.5 %; OR 3.0, 95 %CI 1.4 - 6.5). Mortality was 31.6 %. In the multivariate analysis, the variables associated with mortality were the hypothesis of IFI (OR 6.35; 95 % CI 3.63–11.12.0), lung abnormalities on HRCT (57.9 % and 26.9 %; OR 2 0.6; 95 % CI 1.5 – 4.4), and positive GM test (57.9 % and 26.9 %; OR 2.7 95 % CI 1.6 - 4.5). Conclusions: Positive GM test was associated with lung abnormalities on HRCT and with the introduction of therapeutic antifungals. If adequate anti-mold prophylaxis is available, the GM test should not be used as screening, but to investigate IFI in high-risk patients. The diagnosis of IFI, positive GM test and lung abnormalities on HRCT were predictors of hospital mortality in patients with hematological malignancies or undergoing HSCT.http://www.sciencedirect.com/science/article/pii/S1413867024000011Invasive aspergillosisFungal infectionGalactomannan testMortalityHematological malignanciesHematopoietic cell transplantation |
| spellingShingle | Lucieni Oliveira Conterno Plínio Trabasso Mariângela Ribeiro Resende Paula Sanches Paschoali Leticia Bergamo Pascucci Maria Luiza Moretti Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital Brazilian Journal of Infectious Diseases Invasive aspergillosis Fungal infection Galactomannan test Mortality Hematological malignancies Hematopoietic cell transplantation |
| title | Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital |
| title_full | Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital |
| title_fullStr | Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital |
| title_full_unstemmed | Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital |
| title_short | Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital |
| title_sort | six year experience with gm test in hematological patients in a public brazilian tertiary hospital |
| topic | Invasive aspergillosis Fungal infection Galactomannan test Mortality Hematological malignancies Hematopoietic cell transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S1413867024000011 |
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