Background The diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging, and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. Objectives This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. Methods All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius(R)). IPA was diagnosed according to appropriate criteria for each patient group. Results We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95% CI 47-79) and specificity 99% (95% CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95% CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.

Aspergillus-PCR in bronchoalveolar lavage - diagnostic accuracy for invasive pulmonary aspergillosis in critically ill patients

Mikulska, Malgorzata;Furfaro, Elisa;Dettori, Silvia;Giacobbe, Daniele Roberto;Magnasco, Laura;Dentone, Chiara;Ball, Lorenzo;Russo, Chiara;Taramasso, Lucia;Vena, Antonio;Angelucci, Emanuele;Pelosi, Paolo;Bassetti, Matteo
2022

Abstract

Background The diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging, and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. Objectives This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. Methods All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius(R)). IPA was diagnosed according to appropriate criteria for each patient group. Results We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95% CI 47-79) and specificity 99% (95% CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95% CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11567/1095339
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