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Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment

Matthieu Legrand 1, 2, 3 Maud Gits-Muselli 4 Louis Boutin 2 Dea Garcia-Hermoso 5, 6 Véronique Maurel 2 Sabri Soussi 2 Mourad Benyamina 2 Axelle Ferry 2 Maïté Chaussard 2 Samia Hamane 7 Blandine Denis 8 Sophie Touratier 9 Nicolas Guigue 4 Emilie Frealle 10, 7 Mathieu Jeanne 11 Jean-Vivien Shaal 12 Charles Soler 12 Maurice Mimoun 13 Marc Chaouat 13, 3 Matthieu Lafaurie 8 Alexandre Mebazaa 3, 2 Stéphane Bretagne 6, 5, 3, 4 Alexandre Alanio 6, 5, 3, 4
1 BioCANVAS - Biomarqueurs CArdioNeuroVASCulaires
2 Service d'Anesthésie et Soins Intensifs
3 UPD7 - Université Paris Diderot - Paris 7
4 Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris]
5 CNRMA - Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire
6 Mycologie moléculaire
7 Parasito - Myco - LILLE - Laboratoire de Parasitologie et Mycologie
8 Service de maladies infectieuses et tropicales [Saint-Louis]
9 Pharmacie, Hôpital Saint-Louis
10 CIIL - Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204
11 Pôle d'Anesthésie Réanimation
12 Hôpital d'Instruction des Armées Percy
13 Service de Chirurgie Plastique et Reconstruction
Abstract : BACKGROUND: Invasive wound mucormycosis (IWM) is associated with an extremely poor outcome among critically ill burn patients. We describe the detection of circulating Mucorales DNA (cmDNA) for the early diagnosis of IWM in those patients and report the potential value of detecting cmDNA for treatment guidance. METHODS: Severely ill burn patients admitted to our tertiary referral center between October 2013 and February 2016 were included. Retrospective plasma samples were tested for the presence of cmDNA by quantitative real-time polymerase chain reaction (qPCR). Patients were then prospectively screened twice a week, and liposomal amphotericin-B therapy initiated based on a positive qPCR. The primary endpoint was the time between cmDNA detection and standard diagnosis. Secondary endpoints were the time from cmDNA detection and treatment initiation and mortality. RESULTS: Seventy-seven patients (418 samples) were included. The average age was 46 (28-60) years, abbreviated burn severity index was 8 (7-10), and simplified acute physiology score was 33 (23-46). The total body surface area was 33% (22%-52%). cmDNA was detected 11 (4.5-15) days before standard diagnosis. The in-hospital mortality was 62% for patients with IWM and 24% for those without (P = .03). The mortality due to IWM was 80% during period A and 33% during period B (P = .46). CONCLUSIONS: This study suggests that the detection of cmDNA allows earlier diagnosis of IWM in severely ill burn patients and earlier initiation of treatment. Further studies are needed to confirm the impact of earlier treatment initiation on patient outcome.
Keywords : screening early treatment immunocompromised invasive fungal infection DNA
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https://hal-pasteur.archives-ouvertes.fr/pasteur-01405205
Contributor : Floran Bidault Connect in order to contact the contributor
Submitted on : Tuesday, November 29, 2016 - 4:13:50 PM
Last modification on : Friday, November 5, 2021 - 5:26:02 PM

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PASTEUR | CNRS | UNIV-PARIS7 | SSA | RIIP_LILLE | USPC | UNIV-PARIS13 | RIIP | UNIV-LILLE | SORBONNE-PARIS-NORD | UNIV-PARIS | CIIL

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Matthieu Legrand, Maud Gits-Muselli, Louis Boutin, Dea Garcia-Hermoso, Véronique Maurel, et al.. Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment. Clinical Infectious Diseases, Oxford University Press (OUP), 2016, 63 (10), pp.1312--1317. ⟨10.1093/cid/ciw563⟩. ⟨pasteur-01405205⟩

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