Abstract
IntroductionThe incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival. Serum biomarker tests for IPA typically give false-negative results in non-neutropenic patients, and galactomannan (GM) detection, the preferred diagnostic test for IPA using bronchoalveolar lavage (BAL), is often not readily available. Novel approaches to IPA detection in ICU patients are needed. In this multicenter study, we evaluated the performance of an Aspergillus lateral-flow device (LFD) test for BAL IPA detection in critically ill patients.MethodsA total of 149 BAL samples from 133 ICU patients were included in this semiprospective study. Participating centers were the medical university hospitals of Graz, Vienna and Innsbruck in Austria and the University Hospital of Mannheim, Germany. Fungal infections were classified according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria.ResultsTwo patients (four BALs) had proven IPA, fourteen patients (sixteen BALs) had probable IPA, twenty patients (twenty-one BALs) had possible IPA and ninety-seven patients (one hundred eight BALs) did not fulfill IPA criteria. Sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratios for diagnosing proven and probable IPA using LFD tests of BAL were 80%, 81%, 96%, 44% and 17.6, respectively. Fungal BAL culture exhibited a sensitivity of 50% and a specificity of 85%.ConclusionLFD tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available.Trial registrationClinicalTrials.gov NCT02058316. Registered 20 January 2014.
Highlights
The incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival
Known risk factors for IPA were present in the majority of the study population, and these included chronic obstructive pulmonary disease (COPD) (32 (21.5%) of 149;), acute leukemia (18 (12%) of 149), neutropenia (18 (12%) of 149), chronic systemic corticosteroid use (11 (7%) of 149), bone marrow transplantation (9 (6%) of 149), bronchial carcinoma (8 (5%) of 149), influenza A viral pneumonia (7 (5%) of 149) and liver cirrhosis and/or alcoholic hepatitis (6 (4%) of 149)
We calculated lateral-flow device (LFD) test performance with predefined EORTC/Mycoses Study Group (MSG) criteria [34] and a previously published clinical algorithm [35], and we found comparable test performance
Summary
The incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival. Novel approaches to IPA detection in ICU patients are needed. In this multicenter study, we evaluated the performance of an Aspergillus lateral-flow device (LFD) test for BAL IPA detection in critically ill patients. Invasive pulmonary aspergillosis (IPA) caused by the ubiquitous environmental mold Aspergillus is a leading cause of morbidity and mortality in immunocompromised patients, including those in intensive care units (ICUs) [1]. The level of circulating GM in the bloodstream may be too low to be detected [12,13]
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