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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.
  • Mikulska M; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Furfaro E; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Dettori S; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Giacobbe DR; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Magnasco L; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Dentone C; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Ball L; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Russo C; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Taramasso L; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Vena A; Anesthesia and Intensive Care, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Angelucci E; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
  • Pelosi P; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
  • Bassetti M; Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Mycoses ; 65(4): 411-418, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1685386
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® ). 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 < .001.

CONCLUSIONS:

Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Randomized controlled trials Limits: Humans Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13428

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Randomized controlled trials Limits: Humans Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13428