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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Does galactomannan testing increase diagnostic accuracy for IPA in the ICU? A prospective observational study

Authors: Maria Schroeder, Marcel Simon, Juri Katchanov, Charles Wijaya, Holger Rohde, Martin Christner, Azien Laqmani, Dominic Wichmann, Valentin Fuhrmann, Stefan Kluge

Published in: Critical Care | Issue 1/2016

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Abstract

Background

An algorithm for distinguishing invasive pulmonary aspergillosis (IPA) in critically ill patients (AspICU) has been proposed but not tested.

Methods

This was a prospective observational study applying the AspICU protocol to patients with positive Aspergillus culture (PAC group) and those with negative aspergillus culture but positive galactomannan test in respiratory tract samples (only positive galactomannan (OPG group)). Patients underwent a standardized diagnostic workup with bronchoscopy, computed tomography (CT), and galactomannan determination in serum and bronchoalveolar lavage fluid (BALF).

Results

We included 85 patients in the study. Of these, 43 had positive aspergillus cultures and 42 patients had only a positive galactomannan test. There were no statistically significant differences in baseline characteristics, underlying conditions or ICU scores between the two groups. The galactomannan titre in BALF was significantly higher in the positive aspergillus culture (PAC) group (enzyme immunoassay (EIA) 5.9, IQR 3.2–5.7) than in the OPG group (EIA 1.7, IQR 0.9–4.5) (p < 0.001). Classic features of IPA were detected on CT in 37.5 % and 36.6 % of patients in the PAC and OPG groups, respectively. There were no statistically significant differences between the PAC and the OPG group in relation to AspICU or European Organization for the Research and Treatment of Cancer (EORTC) criteria. A positive aspergillus culture was a stronger trigger for initiating antimycotic treatment than positive BALF galactomannan: 88.4 % of patients in the PAC group were regarded by clinicians as having IPA and received antimycotic treatment as opposed to 59.5 % in the OPG group (p = 0.002). The 180-day mortality was 58.1 % in the PAC group and 59.5 % in the OPG group.

Conclusions

The inclusion of BALF galactomannan as an additional entry criterion for the AspICU clinical algorithm could increase the diagnostic sensitivity for IPA in ICU patients.

Trial registration

The study was registered at ClinicalTrials.gov (registration number NCT01866020) on 27 May 2013.
Appendix
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Metadata
Title
Does galactomannan testing increase diagnostic accuracy for IPA in the ICU? A prospective observational study
Authors
Maria Schroeder
Marcel Simon
Juri Katchanov
Charles Wijaya
Holger Rohde
Martin Christner
Azien Laqmani
Dominic Wichmann
Valentin Fuhrmann
Stefan Kluge
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1326-1

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