支气管肺泡灌洗液曲霉 PCR 检测 - 危重症患者侵袭性肺曲霉病的诊断准确性。

Aspergillus-PCR in bronchoalveolar lavage - diagnostic accuracy for invasive pulmonary aspergillosis in critically ill patients.

机构信息

Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.

Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.

出版信息

Mycoses. 2022 Apr;65(4):411-418. doi: 10.1111/myc.13428. Epub 2022 Feb 17.

DOI:10.1111/myc.13428

PMID:35138675

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.

摘要

背景

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。

目的

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。

方法

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。

结果

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。