Prospective screening by a panfungal polymerase chain reaction assay in patients at risk for fungal infections: implications for the management of febrile neutropenia

Invasive fungal infections are a major cause of mortality in neutropenic ca ncer patients. To determine whether a polymerase chain reaction (PCR)-based assay enabled the identification of patients at risk for invasive fungal i nfections, a prospective monitoring once per week was performed during 92 n eutropenic episodes in patients receiving chemotherapy for acute leukaemia or high-dose therapy followed by allogeneic or autologous stem cell transpl antation, with the investigators blinded to clinical and microbiological da ta. PCR positivity was documented in 34 out of 92 risk episodes. All patien ts developing proven invasive fungal infection were found PCR positive, and PCR was found to be the earliest indicator of invasive fungal infection pr eceding clinical evidence by a mean of 5.75 d (range 0-14 d). In febrile ne utropenic patients without a prior history of invasive fungal infection, a sensitivity of 100% and a specificity of 73% of the PCR assay for the devel opment of proven or probable invasive fungal infection was documented. In c onclusion, panfungal PCR performed prospectively once a week enabled the id entification of patients at high risk for invasive fungal infections.