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Legrand M, Gits-Muselli M, Boutin L, Garcia-Hermoso D, Maurel V, Soussi S, Benyamina M, Ferry A, Chaussard M, Hamane S, Denis B, Touratier S, Guigue N, Fréalle E, Jeanne M, Shaal JV, Soler C, Mimoun M, Chaouat M, Lafaurie M, Mebazaa A, Bretagne S, Alanio A. Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment. Clin Infect Dis 2016; 63:1312-1317. [PMID: 27535951 DOI: 10.1093/cid/ciw563] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/13/2016] [Indexed: 02/04/2023] Open
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.
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Affiliation(s)
- Matthieu Legrand
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris Diderot, Sorbonne Paris Cité.,UMR 942, INSERM
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Louis Boutin
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Dea Garcia-Hermoso
- Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques.,CNRS URA3012
| | - Véronique Maurel
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Sabri Soussi
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Mourad Benyamina
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Axelle Ferry
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Maïté Chaussard
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Blandine Denis
- Service de Maladies Infectieuses et Tropicales, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Sophie Touratier
- Pharmacie, Hôpital St-Louis, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris
| | - Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Emilie Fréalle
- Univ. Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, CNRS, UMR 8204, Inserm, U1019, CHU Lille, Laboratoire de Parasitologie- Mycologie, Institut Pasteur de Lille
| | - Mathieu Jeanne
- CHU Lille, Centre de Traitement des Brûlés, Pôle d'Anesthésie-Réanimation, Lille
| | | | - Charles Soler
- Service de Biologie médicale, Hopital d'instruction des Armées, Clamart
| | - Maurice Mimoun
- Université Paris Diderot, Sorbonne Paris Cité.,Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Marc Chaouat
- Université Paris Diderot, Sorbonne Paris Cité.,Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Matthieu Lafaurie
- Service de Maladies Infectieuses et Tropicales, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal
| | - Alexandre Mebazaa
- Anesthesiology, Critical Care and Burn Unit, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Université Paris Diderot, Sorbonne Paris Cité.,UMR 942, INSERM
| | - Stéphane Bretagne
- Université Paris Diderot, Sorbonne Paris Cité.,Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques.,CNRS URA3012
| | - Alexandre Alanio
- Université Paris Diderot, Sorbonne Paris Cité.,Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal.,Unité de Mycologie Moléculaire, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques.,CNRS URA3012
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