Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, adult patients: A systematic review with qualitative evidence synthesis. Issue 1 (July 2020)

• Record Type: Journal Article
• Authors: Akova, M.; Alastruey-Izquierdo, A.; Arikan-Akdagli, S.; Azoulay, E.; Blot, S.; Cornely, O.A.; Lass-Flörl, C.; Koehler, P.; Cuenca-Estrella, M.; de Lange, D.W.; De Rosa, F.G.; De Waele, J.J.; Dimopoulos, G.; Garnacho-Montero, J.; Hoenigl, M.; Kanj, S.S.; Lamoth, F.; Maertens, J.; Martin-Loeches, I.; Muñoz, P.; Kullberg, B.J.; Agvald-Ohman, C.; Poulakou, G.; Rello, J.; Righi, E.; Sanguinetti, M.; Taccone, F.S.; Timsit, J-F.; Torres, A.; Vazquez, J.A.; Wauters, J.; Calandra, T.; Asperges, E.; Tejada, S.; Lebihan, C.; Karaiskos, I.; Peghin, M.; Mortensen, K.L.; Vena, A.; Cortegiani, A.; Mercier, T.; Bassetti, M.; Giacobbe, D.R.; Grecchi, C.; Rebuffi, C.; Zuccaro, V.; Scudeller, L.;
• Is Part Of: Journal of infection. Volume 81:Issue 1(2020)
• Page Start: 131
• Page End: 146
• Publication Date: 2020-07
• Subjects: Aspergillus -- Diagnosis -- Biomarker -- IA -- IPA -- Invasive aspergillosis; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2020.03.065
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: This systematic review will guide discussions within the FUNDICU project. Most available data pertained to IPA. The AspICU definition showed a promising diagnostic performance against histology. A better diagnostic performance of BALF GM than serum GM was observed. Suboptimal specificity was observed for BALF and serum (1, 3)-β-D -glucan. Abstract: Objectives: To summarize the available evidence on the diagnostic performance for invasive aspergillosis (IA) in non-hematological, non-solid organ transplantation critically ill patients of the following: ( i ) existing definitions of IA (developed either for classical immunocompromised populations or for non-immunocompromised critically ill patients); ( ii ) laboratory tests; ( iii ) radiology tests. Methods: A systematic review was performed by evaluating studies assessing the diagnostic performance for IA of a definition/s and/or laboratory/radiology test/s vs. a reference standard (histology) or a reference definition. Results: Sufficient data for evaluating the performance of existing definitions and laboratory tests for the diagnosis of IA in critically ill patients is available only for invasive pulmonary aspergillosis. Against histology/autopsy as reference, the AspICU definition showed a promising diagnostic performance but based on small samples and applicable only to patients with positive respiratory cultures. Studies on laboratory tests consistently indicated a better diagnostic performance of bronchoalveolar lavage fluid (BALF) galactomannan (GM) than serum GM, and a suboptimal specificity of BALF and serum (1, 3)-β-D -glucan. Conclusions: Evidence stemming from this systematic review will guide the discussion for defining invasive aspergillosis within the FUNDICU project. The project aims to develop a standard set of definitions for invasive fungal diseases in critically ill, adult patients.