Point of care aspergillus testing in intensive care patients.
Aged
Belgium
/ epidemiology
Diagnostic Techniques and Procedures
/ standards
Female
Humans
Intensive Care Units
/ organization & administration
Invasive Pulmonary Aspergillosis
/ diagnosis
Male
Middle Aged
Netherlands
/ epidemiology
Point-of-Care Testing
ROC Curve
Sensitivity and Specificity
Time Factors
Diagnosis
Galactomannan
Invasive aspergillosis
Lateral flow assay
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
10 11 2020
10 11 2020
Historique:
received:
09
07
2020
accepted:
29
10
2020
entrez:
10
11
2020
pubmed:
11
11
2020
medline:
25
6
2021
Statut:
epublish
Résumé
Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with influenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecific. Recently, Aspergillus lateral flow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fluid (BALf) from hematology patients. We therefore evaluated a new lateral flow test for IPA in ICU patients. Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral flow assay (LFA) by IMMY (Norman, OK, USA). Patients were classified according to the 2008 EORTC-MSG definitions, the AspICU criteria, and the modified AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus definitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the final clinical diagnosis and IPA classification. We included 178 patients, of which 55 were classified as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG definitions, and an additional 23 cases according to the modified AspICU criteria). Depending on the definitions used, the sensitivity of the LFA was 0.88-0.94, the specificity was 0.81, and the area under the ROC curve 0.90-0.94, indicating good overall test performance. In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.
Sections du résumé
BACKGROUND
Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with influenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecific. Recently, Aspergillus lateral flow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fluid (BALf) from hematology patients. We therefore evaluated a new lateral flow test for IPA in ICU patients.
METHODS
Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral flow assay (LFA) by IMMY (Norman, OK, USA). Patients were classified according to the 2008 EORTC-MSG definitions, the AspICU criteria, and the modified AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus definitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the final clinical diagnosis and IPA classification.
RESULTS
We included 178 patients, of which 55 were classified as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG definitions, and an additional 23 cases according to the modified AspICU criteria). Depending on the definitions used, the sensitivity of the LFA was 0.88-0.94, the specificity was 0.81, and the area under the ROC curve 0.90-0.94, indicating good overall test performance.
CONCLUSIONS
In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.
Identifiants
pubmed: 33168049
doi: 10.1186/s13054-020-03367-7
pii: 10.1186/s13054-020-03367-7
pmc: PMC7652676
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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