New clinical algorithm including fungal biomarkers to better diagnose probable invasive pulmonary aspergillosis in ICU - 08/01/26
Collaborative RESSIF group
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
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.
Patients and methods |
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.
Results |
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.
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Invasive aspergillosis, Intensive care unit, Clinical algorithm, Fungal biomarkers, Galactomannan antigen, Aspergillus qPCR
Keywords : Medical and Health Sciences, Clinical Sciences
Plan
Vol 11 - N° 1
Article 41- 2021 Retour au numéro
Article précédent
- High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study
- Nicolas Bonnet, Olivier Martin, Marouane Boubaya, Vincent Levy, Nathan Ebstein, Philippe Karoubi, Yacine Tandjaoui-Lambiotte, Guillaume Van Der Meersch, Johanna Oziel, Marie Soulie, Mohamed Ghalayini, Anais Winchenne, Jean Ralph Zahar, Passem Ahmed, Stéphane Gaudry, Yves Cohen
- Pain and dyspnea control during awake fiberoptic bronchoscopy in critically ill patients: safety and efficacy of remifentanil target-controlled infusion
- Margot Caron, Antoine Parrot, Alexandre Elabbadi, Sophie Dupeyrat, Matthieu Turpin, Thomas Baury, Sacha Rozencwajg, Clarisse Blayau, Jean-Pierre Fulgencio, Aude Gibelin, Pierre-Yves Blanchard, Séverine Rodriguez, Daisy Daigné, Marie-Cécile Allain, Muriel Fartoukh, Tài Pham
Bienvenue sur EM-consulte, la référence des professionnels de santé.