Performance of Existing Definitions and Tests for the Diagnosis of Invasive Fungal Diseases other than Invasive Candidiasis and Invasive Aspergillosis in Critically Ill, Adult Patients: A Systematic Review with Qualitative Evidence Synthesis.

Erika Asperges,Ilias Karaiskos,Matteo Bassetti,Maddalena Peghin,Luigia Scudeller,The Fundicu Investigators ,Chiara Rebuffi,Cecilia Grecchi,Valentina Zuccaro,Sofia Tejada,Andrea Cortegiani,Toine Mercier,Daniele Giacobbe

doi:10.3390/jof7030176

Abstract

The Fungal Infections Definitions in Intensive Care Unit (ICU) patients (FUNDICU) project aims to provide standard sets of definitions for invasive fungal diseases (IFDs) in critically ill, adult patients, including invasive aspergillosis (IA), invasive candidiasis (IC), Pneumocystis jirovecii pneumonia (PJP), and other non-IA, non-IC IFDs. The first step of the project was the conduction of separated systematic reviews of the characteristics and applicability to critically ill, adult patients outside classical populations at risk (hematology patients, solid organ transplant recipients) of available definitions and diagnostic tests for IFDs. We report here the results of two systematic reviews exploring the performance of available definitions and tests, for PJP and for other non-IA, non-IC IFDs. Starting from 2585 and 4584 records for PJP and other IFDs, respectively, 89 and 61 studies were deemed as eligible for full-text evaluation. However, only two studies for PJP and no studies for other IFDs met the FUNDICU protocol criteria for inclusion in qualitative synthesis. Currently, there is no sufficient solid data for directly evaluating the performance of existing definitions and laboratory tests for the diagnosis of PJP and other non-IA, non-IC IFDs in critically ill adult patients outside classical populations at risk.

Highlights

IntroductionThe diagnosis of some invasive fungal diseases (IFDs) (e.g., invasive aspergillosis (IA)) is difficult in non-neutropenic, non-hematology populations, owing to the frequent absence of proven diagnosis (histology or culture from normally sterile sites), the suboptimal performance of definitions developed for severely immunocompromised patients, and the lack of wide consensus about alternative sets of definitions that have been proposed over the years [5,6,7,8,9]
Both were single center studies; one was a prospective cohort study and the other one a retrospective cross-sectional study. Both evaluated the diagnostic performance of polymerase chain reaction reference test, conventional stain plus immunofluorescent assay [12], or microscopic exami(PCR) tests against a reference test, conventional stain plus immunofluorescent assay [12], nation [13] for the identification of Pneumocystis jirovecii
Data regarding the diagnostic performance of tests or existing definitions for invasive fungal diseases (IFDs) other

Summary

Introduction

The diagnosis of some IFDs (e.g., IA) is difficult in non-neutropenic, non-hematology populations, owing to the frequent absence of proven diagnosis (histology or culture from normally sterile sites), the suboptimal performance of definitions developed for severely immunocompromised patients, and the lack of wide consensus about alternative sets of definitions that have been proposed over the years [5,6,7,8,9] This lack of standard definitions does not regard only IA and IC, and other less common IFDs that may be encountered in critically ill patients, such as pneumocystosis and infections due to other yeasts and molds. The first step of the project was the conduction of separated systematic reviews of the characteristics and applicability to critically ill, adult patients of available definitions and diagnostic tests for IFDs: (i) IA; (ii) IC; (iii) other IFDs.

Methods

Results

Conclusion