Background: Invasive pulmonary aspergillosis (IPA) is an increasingly recognized complication in intensive care unit (ICU) patients, especially those with infuenza, cirrhosis, chronic obstructive pulmonary disease, and other diseases. The diagnosis can be challenging, especially in the ICU, where clinical symptoms as well as imaging are mostly nonspecifc. Recently, Aspergillus lateral fow tests were developed to decrease the time to diagnosis of IPA. Several studies have shown promising results in bronchoalveolar lavage fuid (BALf ) from hematology patients. We therefore evaluated a new lateral fow test for IPA in ICU patients. Methods: Using left-over BALf from adult ICU patients in two university hospitals, we studied the performance of the Aspergillus galactomannan lateral fow assay (LFA) by IMMY (Norman, OK, USA). Patients were classifed according to the 2008 EORTC-MSG defnitions, the AspICU criteria, and the modifed AspICU criteria, which incorporate galactomannan results. These internationally recognized consensus defnitions for the diagnosis of IPA incorporate patient characteristics, microbiology and radiology. The LFA was read out visually and with a digital reader by researchers blinded to the fnal clinical diagnosis and IPA classifcation. Results: We included 178 patients, of which 55 were classifed as cases (6 cases of proven and 26 cases of probable IPA according to the EORTC-MSG defnitions, and an additional 23 cases according to the modifed AspICU criteria). Depending on the defnitions used, the sensitivity of the LFA was 0.88–0.94, the specifcity was 0.81, and the area under the ROC curve 0.90–0.94, indicating good overall test performance. Conclusions: In ICU patients, the LFA performed well on BALf and can be used as a rapid screening test while waiting for other microbiological results.

Invasive aspergillosis, Diagnosis, Lateral fow assay, Galactomannan,
Critical Care

Mercier, T., Dunbar, A., Veldhuizen, V., Holtappels, M., Schauwvlieghe, A., Maertens, J, … Wauters, J. (2020). Point of care aspergillus testing in intensive care patients. Critical Care, 24(1). doi:10.1186/s13054-020-03367-7