Galactomannan antigen detection using bronchial wash and bronchoalveolar lavage in patients with hematologic malignancies. Issue 1 (December 2015)

• Record Type: Journal Article
• Authors: Taremi, Mahnaz; Kleinberg, Michael; Wang, Elizabeth; Gilliam, Bruce; Ryscavage, Patrick
• Is Part Of: Annals of clinical microbiology and antimicrobials. Volume 14:Issue 1(2015)
• Page Start: 1
• Page End: 3
• Publication Date: 2015-12
• Subjects: Galactomannan antigen -- Bronchial wash -- Bronchoalveolar lavage -- Invasive pulmonary aspergillosis; Medical microbiology -- Periodicals; Anti-infective agents -- Periodicals; 616.9041
• DOI: 10.1186/s12941-015-0111-3
• Languages: English
• ISSNs: 1476-0711

Abstract

Abstract Background The diagnosis of invasive pulmonary aspergillosis is challenging. It is unclear whether galactomannan (GM) results from bronchial wash (BW) and bronchoalveolar lavage (BAL) samples differ in a clinically meaningful way. Results Ninety-six paired (BAL and BW) samples from 85 patients were included. The average age was 53 years, 61 % of the patients were male, and 74.1 % had an underlying diagnosis of AML/MDS (ALL 7.1 %, other hematologic malignancy 18.8 %). 57 (67.1 %) patients were neutropenic, and 56 (65.9 %) patients were receiving mold-active drugs at least 48 h prior to bronchoscopy. The overall agreement between GM detection from BW and BAL was 63.5 % (K = 0.152; 95 % CI 0.008–0.311) and 73 % (K = 0.149; 95 % CI 0.048–0.348) at cut off ≥0.5 and ≥1.0, respectively. Among 43 positive samples, using a GM cut-off of 0.5, 39 (90.5 %) were positive in BW samples whereas 12 (29.3 %) were positive in BAL samples. The median level of GM in BW (0.28) samples was significantly higher than in BAL (0.20) samples among 53 samples with negative results (P = 0.001). There was no statistically significant difference in the median GM values between the BW and BAL samples with positive results (P = 0.08). There was no significant difference in GM detection between samples with positive and negative results with regard to antifungal, beta lactam antibacterial treatment or neutropenia (60.5 vs 56.6 %; 53.9 vs 46 %; 65.1 vs 54.7 %, respectively). Conclusion This retrospective study examining two collection techniques suggests that BW may have higher diagnostic yield compared to bronchoalveolar lavage for GM detection.