Hamam Joffrey, Navellou Jean-Christophe, Bellanger Anne-Pauline, Bretagne Stéphane, Winiszewski Hadrien, Scherer Emeline, Piton Gael, Millon Laurence
Medical Intensive Care Unit, University Hospital of Besançon, 25000, Besancon, France.
Intensive Care Unit, Libourne Hospital, 33500, Libourne, France.
Ann Intensive Care. 2021 Mar 8;11(1):41. doi: 10.1186/s13613-021-00827-3.
The classification of invasive pulmonary aspergillosis (IPA) issued by the European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) is used for immunocompromised patients. An alternative algorithm adapted to the intensive care unit (ICU) population has been proposed (AspICU), but this algorithm did not include microbial biomarkers such as the galactomannan antigen and the Aspergillus quantitative PCR. The objective of the present pilot study was to evaluate a new algorithm that includes fungal biomarkers (BM-AspICU) for the diagnosis of probable IPA in an ICU population.
Data from 35 patients with pathology-proven IPA according to European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSGERC)-2008 criteria were extracted from the French multicenter database of the Invasive Fungal Infections Surveillance Network (RESSIF). The patients were investigated according to the AspICU algorithm, and the BM-AspICU algorithm in analyzing the clinical, imaging, and biomarker data available in the records, without taking into account the pathology findings.
Eight patients had to be excluded because no imaging data were recorded in the database. Among the 27 proven IPAs with complete data, 16 would have been considered as putative IPA with the AspICU algorithm and 24 would have been considered as probable IPA using the new algorithm BM-AspICU. Seven out of the 8 patients with probable BM-AspICU IPA (and not classified with the AspICU algorithm) had no host factors and no Aspergillus-positive broncho-alveolar lavage fluid (BALF) culture. Three patients were non-classifiable with any of the two algorithms, because they did not have any microbial criteria during the course of the infection, and diagnosis of proven aspergillosis was done using autopsy samples.
Inclusion of biomarkers could be effective to identify probable IPA in the ICU population. A prospective study is needed to validate the routine application of the BM-AspICU algorithm in the ICU population.
欧洲癌症研究与治疗组织/真菌病研究组教育与研究联盟（EORTC/MSGERC）发布的侵袭性肺曲霉病（IPA）分类用于免疫功能低下患者。已提出一种适用于重症监护病房（ICU）人群的替代算法（AspICU），但该算法未包括半乳甘露聚糖抗原和曲霉定量PCR等微生物生物标志物。本初步研究的目的是评估一种包含真菌生物标志物的新算法（BM - AspICU）用于诊断ICU人群中可能的IPA。
根据欧洲癌症研究与治疗组织/真菌病研究组（EORTC/MSGERC）-2008标准，从法国侵袭性真菌感染监测网络（RESSIF）的多中心数据库中提取35例经病理证实为IPA患者的数据。根据AspICU算法以及BM - AspICU算法对患者进行调查，分析记录中可用的临床、影像学和生物标志物数据，而不考虑病理结果。
8例患者因数据库中未记录影像学数据而被排除。在27例有完整数据的经证实的IPA患者中，使用AspICU算法时16例将被视为疑似IPA，使用新算法BM - AspICU时24例将被视为可能的IPA。8例可能的BM - AspICU IPA患者（未用AspICU算法分类）中有7例没有宿主因素且支气管肺泡灌洗液（BALF）培养曲霉阴性。3例患者用两种算法均无法分类，因为他们在感染过程中没有任何微生物学标准，经尸检样本诊断为确诊曲霉病。
纳入生物标志物可能有助于在ICU人群中识别可能的IPA。需要进行前瞻性研究以验证BM - AspICU算法在ICU人群中的常规应用。
Zotero 插件