Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
Mycoses. 2022 Apr;65(4):411-418. doi: 10.1111/myc.13428. Epub 2022 Feb 17.
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.
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.
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.
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.
Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.
在重症监护病房（ICU）患者中，侵袭性肺曲霉病（IPA）的诊断具有挑战性，支气管肺泡灌洗（BAL）中曲霉 PCR 的作用尚不清楚。
本研究评估了 BAL 中曲霉 PCR 在三种不同队列的 IPA 中的诊断准确性：COVID-19 入住 ICU 的患者、无 COVID-19 入住 ICU 的患者和免疫功能低下的患者。
所有从三组患者中收集的可用 BAL 样本均用曲霉 PCR（AsperGenius）进行检测。根据每个患者组的适当标准诊断 IPA。
我们纳入了 101 名患者的 111 份 BAL 样本：52 名（51%）因 COVID-19 入住 ICU，24 名（24%）因其他原因入住 ICU，25 名（25%）免疫功能低下。IPA 有 31 例（28%）。曲霉 PCR 的灵敏度为 64%（95%CI 47-79），特异性为 99%（95%CI 93-100）。在 ICU COVID-19 患者中，曲霉 PCR 灵敏度为 40%（95%CI 19-64），非 COVID-19 ICU 患者中为 67%（95%CI 21-93），免疫功能低下患者中为 92%（95%CI 67-98）。IPA 患者与无 IPA 患者的 BAL-GM 和 BAL-PCR 之间的一致性在 ICU 患者中明显较低（32%；COVID-19 中为 43%，非 COVID-19 中为 18%），与免疫功能低下患者（92%）相比，p<.001。
BAL 中的曲霉 PCR 提高了 ICU 患者 BAL-GM 的诊断准确性。
