Milestones

Since its inception in 2006, when 50 individuals met together in a room during International Society for Human and Animal Mycoses (ISHAM) in Paris, the EAPCRI/FPCRI continues to gain momentum. The foundation links 86 participants in 69 centres in 29 countries and has expanded to include centres in North America, Australia and South America. EAPCRI/FPCRI is a cohesive force bringing together Infectious Diseases specialists, medical Microbiologists, Haematologists, Clinical Scientists Epidemiologists, Statisticians and industrial partners working symbiotically together. Systematic research through a series of specimen panels sent out between to 24 test centres across Europe, USA and Australia, followed by meticulous analysis of results and methodologies has produced optimized standardised methodology.

The EAPCRI achieved the following:

• published a Cochrane systematic review of Aspergillus PCR and concluded that PCR showed moderate diagnostic accuracy when used as screening tests for IA in high-risk patient groups. Importantly the sensitivity of the test confers a high negative predictive value (NPV) such that a negative test allows the diagnosis to be excluded.
• developed standards for Aspergillus PCR and published protocols for a variety of specimen types. Importantly, the EAPCRI/FPCRI has assessed the critical stages Aspergillus DNA extraction and published a protocol ensuring optimal performance across laboratories.
• has published an overview of the molecular diagnosis of aspergillosis, covering clinical considerations (e.g. diagnostic strategies, result interpretation or influence of antifungal therapy), technical advice (e.g. optimal protocols for different specimens or contamination issues) and performance comparison in a single comprehensive manuscript.
• involved in the development of an Aspergillus DNA calibrator with the potential to create a WHO International standard allowing PCR assays to be assessed against a single comparator negating the need for a single assay. This process will bring Aspergillus PCR in line with other widely accepted diagnostic PCR assays, such as those for HIV and Hepatitis C.
• providing the opportunity to develop and participate in an External Quality Control programme to enable all laboratories to evaluate performance in using PCR to detect Aspergillus.
• Obtained samples from patients recruited to two prospective trials, a) the AMBIGUARD study (Cornely et al. J Antimicrob Chemother 2017; 72(8): 2359-67.) and b) the strategic trial of the European Organization for Research and Treatment of Cancer (EORTC) Infectious disease and Leukaemia groups (EORTC 65091-06093: ClinicalTrials.gov Identifier: NCT01288378) to assess the diagnostic utility of PCR.
• Gained acceptance within the revised EORTC/MSG consensus definitions for invasive aspergillosis.
• Rebranded the organization as the Fungal PCR initiative (FPCRI), expanding its remit to cover additional the molecular diagnosis of other fungal diseases or manifestations (Candida, Pneumocystis, Mucorales and tissue PCR).