Medizinische Universität Graz - Research portal
Selected Publication:
Guenter, S.
Impact of ITS-based sequencing on antifungal treatment of patients with suspected invasive fungal infections.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 77
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- Authors Med Uni Graz:
- Advisor:
- Gorkiewicz Gregor
- Krause Robert
- Altmetrics:
- Abstract:
- Background Morbidity and Mortality rates of invasive fungal infections have increased considerably over the past decades, especially in immunocompromised patients in ICUs. An early, targeted and systemic antifungal treatment is associated with a successful outcome. Unfortunately, fungal infections are often detected with delay using current diagnostic procedures. The effect of modern molecular diagnostic procedures like ITS PCR and sequencing on antifungal treatment strategies is unclear. The aim of this study was to investigate the impact of ITS PCR and sequencing in the diagnostic process and treatment strategies of patients suffering from invasive fungal infections. Methods Clinical data of selected patients was extracted from the computerised clinical databases “Medocs”. The results of ITS PCR and sequencing were compared to outcomes of fungal culture and microscopy. The impact of ITS PCR and sequencing on antifungal treatment strategies was investigated by review of electronical databases and charts. Results The impact of ITS-sequencing on antifungal treatment strategies in 71 patients (81 samples) with suspected invasive fungal infections was retrospectively investigated. Samples from the respiratory tract were most frequently analysed (lung tissue (n=20); BAL fluid (n=8)). The investigation showed that ITS PCR results were positive in 52% (n=42) of the samples. Additionally, both ITS PCR and cultural results were positive in 24% (n=19) of the samples with concurrent results in 14 out of 19 cases. ITS sequencing either confirmed already ongoing antifungal therapy (19/71 patients, 27%), led to change of antifungal therapy (11/71, 15%) or supported the decision to withhold antifungal treatment (34/71, 48%) (in seven of 71 patients ITS-sequencing results were obtained postmortem). Conclusion ITS-sequencing results led to a change of antifungal therapy in a relevant proportion of patients, while it confirmed therapeutic strategies in the majority. Therefore, ITS sequencing was a useful adjunct to other fungal diagnostic measures in our cohort.