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Accuracy of galactomannan testing on tracheal aspirates in COVID-19-associated pulmonary aspergillosis.
- Source :
-
Mycoses [Mycoses] 2021 Apr; Vol. 64 (4), pp. 364-371. Date of Electronic Publication: 2021 Feb 13. - Publication Year :
- 2021
-
Abstract
- Objective: Our aim was to evaluate the performance of two galactomannan (GM) assays (Platelia Aspergillus EIA, Bio-Rad <superscript>®</superscript> , and Aspergillus GM LFA, IMMY <superscript>®</superscript> ) in tracheal aspirate (TA) samples of consecutive critically ill patients with COVID-19.<br />Methods: We included critically ill patients, performed GM-EIA and GM-Lateral Flow Assay (GM-LFA) in TA and followed them until development of COVID-19-associated pulmonary aspergillosis (CAPA) or alternate diagnosis. CAPA was defined according to the modified AspICU criteria in patients with SARS-CoV-2 infection. We estimated sensitivity, specificity, positive and negative predictive values for GM-EIA, GM-LFA, the combination of both or either positive results for GM-EIA and GM-LFA. We explored accuracy using different breakpoints, through ROC analysis and Youden index to identify the optimal cut-offs. We described antifungal treatment and 30-day mortality.<br />Results: We identified 14/144 (9.7%) patients with CAPA, mean age was 50.35 (SD 11.9), the median time from admission to CAPA was 8 days; 28.5% received tocilizumab and 30-day mortality was 57%. ROC analysis and Youden index identified 2.0 OD as the best cut-off, resulting in sensitivity and specificity of 57.1% and 81.5% for GM-EIA and 60% and 72.6% for GM-LFA, respectively.<br />Conclusions: The diagnostic performance of GM in tracheal aspirates improved after using a cut-off of 2 OD. Although bronchoalveolar lavage testing is the ideal test, centres with limited access to bronchoscopy may consider this approach to identify or rule out CAPA.<br /> (© 2020 Wiley-VCH GmbH.)
- Subjects :
- Adult
Antifungal Agents therapeutic use
Diabetes Complications complications
Female
Galactose analogs & derivatives
Humans
Male
Middle Aged
Obesity complications
Pulmonary Aspergillosis drug therapy
Pulmonary Aspergillosis etiology
Pulmonary Aspergillosis mortality
Sensitivity and Specificity
Trachea microbiology
COVID-19 complications
Mannans analysis
Pulmonary Aspergillosis diagnosis
Trachea chemistry
Subjects
Details
- Language :
- English
- ISSN :
- 1439-0507
- Volume :
- 64
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Mycoses
- Publication Type :
- Academic Journal
- Accession number :
- 33217784
- Full Text :
- https://doi.org/10.1111/myc.13216