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Nested PCR guides antifungal therapy in cancer patients

NEW YORK (Reuters Health) – Early diagnosis and treatment of fungal infections in febrile patients with neutropenia and cancer remain "major challenges" for physicians. However, a new approach to early treatment using nested polymerase chain reaction (PCR) to guide therapeutic decision making could ease this burden while also improving patient outcomes, according to researchers in Taiwan.

If confirmed in a larger, randomized trial, "our results suggest that PCR technologies would probably alter the management policy of the febrile patient with neutropenia and cancer," Dr. Ming-Tsan Lin, of Changhua Christian Hospital, and colleagues conclude in the November 15th issue of Clinical Infectious Diseases.

Dr. Lin's group tested the nested PCR technique in an uncontrolled study involving 42 febrile patients with neutropenia and cancer. Nested PCR and culture were used to detect fungal infections (Candida, Aspergillus, Trichosporon, and Cryptococcus species) in all patients using sequential blood samples. "Instead of the empirical antifungal therapy strategy, amphotericin B treatment was initiated only for patients who had two consecutive positive results by nested PCR," the authors explain.

Nested PCR detected fungal infections between 1 and 8 days earlier than did conventional blood culture. In five cases, PCR results were positive within 3 days of the onset of fever. These early results allowed for earlier initiation of antifungal therapy and appeared to reduce mortality in patients with diagnosed fungal infections.

Compared with historical mortality rates of 47% to 75% in similar populations, mortality in the current cohort was only 29% overall and 23.5% in patients with culture-proven candidemia.

"To the best of our knowledge," the researchers write, "the present study is the first report of antifungal treatment based on the use of a highly sensitive and specific PCR assay in febrile patients with neutropenia."

Clin Infect Dis 2001;33:1621-1627.

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