Schroeder Maria, Simon Marcel, Katchanov Juri, Wijaya Charles, Rohde Holger, Christner Martin, Laqmani Azien, Wichmann Dominic, Fuhrmann Valentin, Kluge Stefan
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Respiratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Crit Care. 2016 May 10;20(1):139. doi: 10.1186/s13054-016-1326-1.
An algorithm for distinguishing invasive pulmonary aspergillosis (IPA) in critically ill patients (AspICU) has been proposed but not tested.
This was a prospective observational study applying the AspICU protocol to patients with positive Aspergillus culture (PAC group) and those with negative aspergillus culture but positive galactomannan test in respiratory tract samples (only positive galactomannan (OPG group)). Patients underwent a standardized diagnostic workup with bronchoscopy, computed tomography (CT), and galactomannan determination in serum and bronchoalveolar lavage fluid (BALF).
We included 85 patients in the study. Of these, 43 had positive aspergillus cultures and 42 patients had only a positive galactomannan test. There were no statistically significant differences in baseline characteristics, underlying conditions or ICU scores between the two groups. The galactomannan titre in BALF was significantly higher in the positive aspergillus culture (PAC) group (enzyme immunoassay (EIA) 5.9, IQR 3.2-5.7) than in the OPG group (EIA 1.7, IQR 0.9-4.5) (p < 0.001). Classic features of IPA were detected on CT in 37.5 % and 36.6 % of patients in the PAC and OPG groups, respectively. There were no statistically significant differences between the PAC and the OPG group in relation to AspICU or European Organization for the Research and Treatment of Cancer (EORTC) criteria. A positive aspergillus culture was a stronger trigger for initiating antimycotic treatment than positive BALF galactomannan: 88.4 % of patients in the PAC group were regarded by clinicians as having IPA and received antimycotic treatment as opposed to 59.5 % in the OPG group (p = 0.002). The 180-day mortality was 58.1 % in the PAC group and 59.5 % in the OPG group.
The inclusion of BALF galactomannan as an additional entry criterion for the AspICU clinical algorithm could increase the diagnostic sensitivity for IPA in ICU patients.
The study was registered at ClinicalTrials.gov (registration number NCT01866020 ) on 27 May 2013.
已提出一种用于区分重症患者侵袭性肺曲霉病（IPA）的算法（AspICU），但尚未进行测试。
这是一项前瞻性观察性研究，将AspICU方案应用于曲霉培养阳性患者（PAC组）以及呼吸道样本曲霉培养阴性但半乳甘露聚糖检测呈阳性的患者（仅半乳甘露聚糖阳性（OPG组））。患者接受了标准化的诊断检查，包括支气管镜检查、计算机断层扫描（CT）以及血清和支气管肺泡灌洗液（BALF）中的半乳甘露聚糖测定。
我们纳入了85例患者进行研究。其中，43例曲霉培养阳性，42例患者仅半乳甘露聚糖检测呈阳性。两组在基线特征、基础疾病或ICU评分方面无统计学显著差异。曲霉培养阳性（PAC）组BALF中的半乳甘露聚糖滴度显著高于OPG组（酶免疫测定（EIA）5.9，四分位间距3.2 - 5.7）（EIA 1.7，四分位间距0.9 - 4.5）（p < 0.001）。PAC组和OPG组分别有37.5%和36.6%的患者在CT上检测到IPA的典型特征。在AspICU或欧洲癌症研究与治疗组织（EORTC）标准方面，PAC组和OPG组之间无统计学显著差异。曲霉培养阳性比BALF半乳甘露聚糖阳性更能促使启动抗真菌治疗：PAC组88.4%的患者被临床医生视为患有IPA并接受了抗真菌治疗，而OPG组为59.5%（p = 0.002）。PAC组180天死亡率为58.1%，OPG组为59.5%。
将BALF半乳甘露聚糖纳入AspICU临床算法的额外纳入标准可提高ICU患者中IPA的诊断敏感性。
该研究于2013年5月27日在ClinicalTrials.gov注册（注册号NCT01866020）。
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