Clinicians say: lack of diagnostic tests, or long TAT of tests, is a main issue when managing patients with suspected invasive fungal infections.
Evidence of sub-optimal mycology practice in UK laboratories In recent years there have been increasing reports of invasive fungal disease and the emergence of more intrinsically resistant species of pathogenic fungi, such as Candida auris. ESPAUR initiated an analysis of current practices in diagnosis and treatment of mycological infections. Key findings published in their 2019 report ‘National mycology laboratory diagnostic capacity for invasive fungal diseases in 2017' (PMID: 31233810) included;
There is a need to improve the UK diagnostic capacity for invasive fungal diseases.
A minority of laboratories have local access to β-glucan and galactomannan testing
Susceptibility testing of Aspergillus is currently conducted by few laboratories
Non-culture based fungal diagnostics The survey showed that fungal diagnostics were not available in most laboratories. β-D-Glucan was only available in 5% of responding laboratories, similarly Aspergillus serum galactomannan was only available in 21% and16% for BAL galactomannan. Aspergillus antibody testing was also mainly referred – as was Cryptococcal antigen testing – both 63%. 14% of laboratories performing Cryptococcus antigen test used lateral flow tests whilst 24% used an agglutination technique.
Opportunity for improvement Detecting Aspergillus-specific antibodies: Detecting aspergillus-specific IgG and IgM is critical to diagnosing chronic pulmonary aspergillosis (CPA). The LDBio product outperformed both ImmunoCAP and precipitins in a UK laboratory evaluations. This qualitative test requires no equipment and gives results in 10 minutes
Opportunity for improvement Aspergillus antigen (galactomannan) for diagnosis of invasive aspergillosis. Early rapid detection is a key factor in effective treatment. Detection of galactomannan in BAL fluid samples is a sensitive diagnostic method for Invasive Aspergillosis. We can now offer ERA Biology Aspergillus galactomannan testing products. This test is available as a rapid lateral flow assay(LFA) and as an EIA in strip-well plates, which makes low number runs more economical. A calibrated lateral flow reader is available which makes the LFA semi-quantitative.
Opportunity for improvement (1-3)-β-D-Glucan. ERA Biology's EIA is suitable for both serum and BAL samples. The provision of 4 sets of reagents allows for more runs which makes the ERA Biology kit more economical for individual laboratories.
Antifungal Susceptibility Testing Whilst 77% of respondent’s susceptibility test Candida spp. on-site, 81% referred Aspergillus susceptibility testing. Most respondents did not do susceptibility tests for Aspergillus isolated from patients on treatment. 13% tested where ABPA was involved, 16% for aspergilloma and 22% for chronic aspergillosis.Of the laboratories that test for antifungal susceptibility on Yeasts 57% used microdilution 43% used Vitek, 32% used E-test and 29% used disks. Of the 19% that did test Aspergillus 51% used microdilution, 31% used E-test and 43% used sequencing.
Opportunity for improvement Susceptibility testing: Many laboratories are sending yeasts and moulds to reference laboratories for susceptibility testing. Mean Turnaround -Time for yeasts quoted by one reference laboratory is 6 days whilst for moulds it quotes 8 days. In-house susceptibility testing of yeasts and moulds should be 1-2 days offering a significant area for improvement.
EUCAST; It is recommended that broth microdilution is used to perform antifungal susceptibility testing of yeasts. are unique, BioConnections have helped UK laboratories introduce MICRONAUT antimycotic broth microdilution products into their routine.
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