Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
J Infect. 2010 Dec;61(6):492-8. doi: 10.1016/j.jinf.2010.08.014. Epub 2010 Sep 15.
A recently developed bronchoalveolar lavage (BAL) galactomannan (GM) assay shows promising results. We evaluated the diagnostic performance of this assay and analyzed risk factors for false-positive results.
A prospective cohort study was performed in a tertiary hospital over a 9-month period. We reviewed all adult patients who underwent GM assays of BAL. Patients were categorized with proven, probable, or possible invasive pulmonary aspergillosis (IPA) according to revised EORTC/MSG definitions. Each patient with a false-positive BAL GM result was matched with three patients with true-negative BAL GM result, and the risk factors for false-positive BAL GM results were determined.
Of 359 enrolled patients, 22 (6%) were diagnosed with IPA (1 proven, 17 probable, and 4 possible). Of the 22 patients with IPA, 17 (77%) had already received antifungal agents before the BAL GM assay was conducted. At an index cutoff value of ≥0.5, the BAL GM assay had a sensitivity of 64% (95% CI 41%-83%) and a specificity of 89% (95% CI 85%-92%). However, at an index cutoff value of ≥0.2, the BAL GM assay had a sensitivity of 86% (95% CI 65%-97%) and a specificity of 74% (95% CI 69%-79%). Of the 52 patients with positive BAL GM assay (≥0.5), 25 (7%) were false-positives. Univariate and multivariate analysis revealed that treatment with piperacillin-tazobactam or ampicillin-sulbactam was associated with false-positive BAL GM results.
The BAL GM assay appears promising for the diagnosis of IPA. However, treatment with certain antibiotics may interfere with the results of the BAL GM assay.
最近开发的支气管肺泡灌洗（BAL）半乳甘露聚糖（GM）检测显示出良好的效果。我们评估了该检测的诊断性能，并分析了假阳性结果的危险因素。
在一家三级医院进行了为期 9 个月的前瞻性队列研究。我们回顾了所有接受 BAL GM 检测的成年患者。根据修订后的 EORTC/MSG 定义，患者被归类为确诊、可能或疑似侵袭性肺曲霉病（IPA）。每个 BAL GM 结果假阳性的患者与三个 BAL GM 结果真阴性的患者相匹配，并确定了 BAL GM 结果假阳性的危险因素。
在 359 名入组患者中，22 名（6%）被诊断为 IPA（1 例确诊，17 例可能，4 例可能）。在 22 例 IPA 患者中，17 例（77%）在进行 BAL GM 检测前已接受抗真菌药物治疗。在指数截断值≥0.5 时，BAL GM 检测的敏感性为 64%（95%CI 41%-83%），特异性为 89%（95%CI 85%-92%）。然而，在指数截断值≥0.2 时，BAL GM 检测的敏感性为 86%（95%CI 65%-97%），特异性为 74%（95%CI 69%-79%）。在 52 例 BAL GM 检测阳性（≥0.5）的患者中，25 例（7%）为假阳性。单因素和多因素分析表明，使用哌拉西林-他唑巴坦或氨苄西林-舒巴坦治疗与 BAL GM 假阳性结果相关。
BAL GM 检测似乎对 IPA 的诊断有一定价值。然而，某些抗生素的治疗可能会干扰 BAL GM 检测的结果。
