P457 Clinical correlation of beta galactomannan with culture and patient outcome in a tertiary care center in south india

Abstract

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM BackgroundInvasive aspergillosis has increased in the last decade. They mainly occur in neutropenic patients (following anticancer treatment) and in patients treated with immunosuppressants and corticosteroids. The galactomannan antigen in serum appears to be a serological method able to aid in the diagnosis of invasive aspergillosis also the antigen detection in bronchoalveolar lavage has proven to be advantageous for the diagnosis of invasive aspergillosis.ObjectivesTo perform galactomannan test on BAL and Serum samples.To correlate the galactomannan results with culture.To correlate the galactomannan positive patients with the clinical outcome.MethodsA total of 175 samples were collected from patients suspected to have fungal infections from the period of January 2018 to March 2022 from a tertiary care center in South India. The galactomannan assay and culture were done for these samples. Data of age, sex, gender, diagnosis, underlying conditions, antifungal treatment, and outcomes were collected.ResultsOut of 175 samples collected from patients suspected with Aspergillosis, 120 were males and 55 were females (7 were repeat samples).The major underlying conditions were diabetes and hypertension, coronary artery disease (CAD), and Hematopoetic malignancy such as B Cell lymphomas, ALL, and AML (Fig. 1).The samples sent for galactomannan assay were serum (107 samples), Bronchial wash (74 samples), BAL (4 samples), and tracheal aspirates (3 samples). The test was performed and cultured (Table 1). The cutoff titer for BAL/sera was taken as an index >0.50A total of 90 patients were galactomannan positive. In which, 13 patients were only KOH positive and 6 were KOH and culture positive.In all, 6 cultures grew Aspergillus sp (1), Aspergillus flavus (2), Aspergillus terreus (1), Aspergillus fumigatus (2).A total of 36 patients out of 90 with galactomannan positive were treated with antifungals like liposomal amphotericin B, voriconazole, itraconazole, and fluconazole.In all, 30 patients were discharged, 10 were discharged at request, 86 left against medical advice, 38 patients succumbed to infection, and 12 were outpatients lost to follow-up.ConclusionGalactomannan alone cannot be taken as a diagnostic marker. Clinical correlation, radiologic findings, as well as underlying risk factors play a major role for decision on the initiation of empiric treatment.