Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship

Hiroshi Ito; Koh Okamoto; Shinya Yamamoto; Marie Yamashita; Yoshiaki Kanno; Daisuke Jubishi; Mahoko Ikeda; Sohei Harada; Shu Okugawa; Kyoji Moriya

doi:10.1093/ofid/ofab601

Incidence and Risk Factors for Inappropriate Use of Non-Culture-Based Fungal Assays: Implication for Diagnostic Stewardship

Open Forum Infect Dis. 2021 Dec 6;9(1):ofab601. doi: 10.1093/ofid/ofab601. eCollection 2022 Jan.

Authors

Hiroshi Ito^{1

2}, Koh Okamoto¹, Shinya Yamamoto¹, Marie Yamashita¹, Yoshiaki Kanno¹, Daisuke Jubishi¹, Mahoko Ikeda¹, Sohei Harada^{1

3}, Shu Okugawa¹, Kyoji Moriya¹

Affiliations

¹ Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.
² Division of Hospital Medicine, University of Tsukuba Hospital, Ibaraki, Japan.
³ Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan.

Abstract

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.

Keywords: beta-D glucan; cryptococcal antigen; diagnostic stewardship; galactomannan antigen.