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Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship
BACKGROUND: Non-culture-based fungal assays (NCBFAs) have been used increasingly to help diagnose invasive fungal diseases. However, little is known about inappropriate use of NCBFAs. We aimed to investigate inappropriate use of NCBFAs in a tertiary academic hospital. METHODS: This retrospective coh...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743121/ https://www.ncbi.nlm.nih.gov/pubmed/35024373 http://dx.doi.org/10.1093/ofid/ofab601 |
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author | Ito, Hiroshi Okamoto, Koh Yamamoto, Shinya Yamashita, Marie Kanno, Yoshiaki Jubishi, Daisuke Ikeda, Mahoko Harada, Sohei Okugawa, Shu Moriya, Kyoji |
author_facet | Ito, Hiroshi Okamoto, Koh Yamamoto, Shinya Yamashita, Marie Kanno, Yoshiaki Jubishi, Daisuke Ikeda, Mahoko Harada, Sohei Okugawa, Shu Moriya, Kyoji |
author_sort | Ito, Hiroshi |
collection | PubMed |
description | BACKGROUND: Non-culture-based fungal assays (NCBFAs) have been used increasingly to help diagnose invasive fungal diseases. However, little is known about inappropriate use of NCBFAs. We aimed to investigate inappropriate use of NCBFAs in a tertiary academic hospital. METHODS: This retrospective cohort study included patients who underwent testing with beta-D glucan (BDG) between January and March 2018 or with galactomannan antigen (GMA) or cryptococcal antigen (CRAG) between January and June 2018. Testing was deemed appropriate if the clinical presentation was compatible with a fungal infection and there was a predisposing host factor at the time of ordering. We compared patients with appropriate and inappropriate use of NCBFAs using multivariate logistic regression analysis. RESULTS: Four hundred seventy patients (BDG, 394; GMA, 138; CRAG, 164) met inclusion criteria and were evaluated. About 80% of NCBFAs were deemed inappropriate. Ordering by transplant medicine physicians, repetitions of the test, the absence of predisposing factors for fungal infections, and the absence of recommendations from infectious diseases consultants were associated with an increased risk of inappropriate NCBFA use. CONCLUSIONS: We found that a large proportion of NCBFAs were deemed inappropriate. There is an opportunity for diagnostic stewardship to reduce avoidable fungal testing among patients at low risk for fungal infection. |
format | Online Article Text |
id | pubmed-8743121 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-87431212022-01-11 Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship Ito, Hiroshi Okamoto, Koh Yamamoto, Shinya Yamashita, Marie Kanno, Yoshiaki Jubishi, Daisuke Ikeda, Mahoko Harada, Sohei Okugawa, Shu Moriya, Kyoji Open Forum Infect Dis Major Article BACKGROUND: Non-culture-based fungal assays (NCBFAs) have been used increasingly to help diagnose invasive fungal diseases. However, little is known about inappropriate use of NCBFAs. We aimed to investigate inappropriate use of NCBFAs in a tertiary academic hospital. METHODS: This retrospective cohort study included patients who underwent testing with beta-D glucan (BDG) between January and March 2018 or with galactomannan antigen (GMA) or cryptococcal antigen (CRAG) between January and June 2018. Testing was deemed appropriate if the clinical presentation was compatible with a fungal infection and there was a predisposing host factor at the time of ordering. We compared patients with appropriate and inappropriate use of NCBFAs using multivariate logistic regression analysis. RESULTS: Four hundred seventy patients (BDG, 394; GMA, 138; CRAG, 164) met inclusion criteria and were evaluated. About 80% of NCBFAs were deemed inappropriate. Ordering by transplant medicine physicians, repetitions of the test, the absence of predisposing factors for fungal infections, and the absence of recommendations from infectious diseases consultants were associated with an increased risk of inappropriate NCBFA use. CONCLUSIONS: We found that a large proportion of NCBFAs were deemed inappropriate. There is an opportunity for diagnostic stewardship to reduce avoidable fungal testing among patients at low risk for fungal infection. Oxford University Press 2021-12-06 /pmc/articles/PMC8743121/ /pubmed/35024373 http://dx.doi.org/10.1093/ofid/ofab601 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Major Article Ito, Hiroshi Okamoto, Koh Yamamoto, Shinya Yamashita, Marie Kanno, Yoshiaki Jubishi, Daisuke Ikeda, Mahoko Harada, Sohei Okugawa, Shu Moriya, Kyoji Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title | Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title_full | Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title_fullStr | Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title_full_unstemmed | Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title_short | Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship |
title_sort | incidence and risk factors for inappropriate use of non-culture-based fungal assays: implication for diagnostic stewardship |
topic | Major Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8743121/ https://www.ncbi.nlm.nih.gov/pubmed/35024373 http://dx.doi.org/10.1093/ofid/ofab601 |
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