支气管肺泡灌洗
医学
曲菌病
曲霉
一致性
内科学
重症监护室
半乳甘露聚糖
胃肠病学
病危
肺
免疫学
微生物学
生物
作者
Małgorzata Mikulska,Elisa Furfaro,Silvia Dettori,Daniele Roberto Giacobbe,Laura Magnasco,Chiara Dentone,Lorenzo Ball,Chiara Russo,Lucia Taramasso,Antonio Vena,Emanuele Angelucci,Paolo Pelosi,Matteo Bassetti
出处
期刊:Mycoses
[Wiley]
日期:2022-02-17
卷期号:65 (4): 411-418
被引量:15
摘要
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.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.All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius® ). IPA was diagnosed according to appropriate criteria for each patient group.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 < .001.Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.
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