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A diagnostic-driven approach to IFIs

A diagnostic approach to treating invasive fungal infections can aid early treatment of patients as well as improving the chances of survival1-4,6

A diagnostic-driven approach allows early treatment (in neutropenic patients with or without fever)1-4

A combination of diagnostic assessments is recommended:5
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  • Monitoring of galactomannan (GM) may be used in patients who have a relatively high probability (>5-10%) of developing invasive aspergillosis (IA)
  • Appropriate clinical and microbiological evaluation
  • High-resolution computed tomography (CT) imaging

    CT section of the lung with halo sign in a patient with haematological malignancy

    Adapted from Green RE et al, 20076

    A diagnostic-driven approach has the potential to help you improve patients' chances of survival6

    • Routine GM screening is shown to lead to the early initiation of antifungal therapy4
    • Initiating appropriate treatment on the basis of CT patterns has been shown to improve survival*6
    • Increased survival was observed in patients with pulmonary invasive aspergillosis who presented with a halo sign versus those with other imaging findings at Week 12: 71% vs 53%, respectively (p<0.01)6

    *Based on analysis of chest CT findings at presentation from a large series (n=235) of patients with invasive pulmonary aspergillosis (IPA), to assess the prevalence of a "halo sign" and to evaluate the clinical utility of this imaging finding for early identification and treatment of IPA6 

    Example of a diagnostic-driven antifungal therapy integrated care pathway7

    Image based on Agrawal S, et al. J Antimicrob Chemother. 2011; 66(Suppl 1): i45-53.
    ​​​​​​​
    *Check response on Day 7. If no response to treatment, further diagnosis is required; if patient responds to treatment, consider the duration of therapy, "step down" therapy, and outpatient follow up.

    Multidisciplinary team input important at this stage.

    IFD, invasive fungal disease; IMD, invasive mould disease; PCR, polymerase chain reaction


    References:
    1. Rogers TR, et al. Br J Haematol. 2011; 153(6): 681–97.
    2. Freemantle N, et al. J Antimicrob Chemother. 2011; 66(Suppl 1): i25–35.
    3. de Pauw BE& Viscoli C. J Antimicrob Chemother. 2011; 66(Suppl 1): i55–8.
    4. Maertens J, et al. Clin Infect Dis. 2005; 41(9): 1242–50.
    5. Marchetti O et al. Bone Marrow Transplant. 2012; 47(6): 846–54.
    6. Greene RE, et al. Clin Infect Dis. 2007; 44(3): 373–9.
    7. Agrawal S, et al. J Antimicrob Chemother. 2011; 66(Suppl 1): i45-53.
    PP-CRB-GBR-1213. August 2021

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    Antifungal Stewardship: Diagnostics Summary.

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    Learn about aspergillosis lateral flow tests

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    Invasive aspergillosis and the ICU

    Underlying conditions in ICU patients

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