Performance of existing definitions and tests for the diagnosis of invasive aspergillosis in critically ill, adult patients: A systematic review with qualitative evidence synthesis: Journal of Infection

M. Bassetti, D.R. Giacobbe, C. Grecchi, C. Rebuffi, V. Zuccaro, L. Scudeller, M. Akova, A. Alastruey-Izquierdo, S. Arikan-Akdagli, E. Azoulay, S. Blot, O.A. Cornely, C. Lass-Flörl, P. Koehler, M. Cuenca-Estrella, D.W. de Lange, F.G. De Rosa, J.J. De Waele, G. Dimopoulos, J. Garnacho-MonteroM. Hoenigl, S.S. Kanj, F. Lamoth, J. Maertens, I. Martin-Loeches, P. Muñoz, B.J. Kullberg, C. Agvald-Ohman, G. Poulakou, J. Rello, E. Righi, M. Sanguinetti, F.S. Taccone, J.-F. Timsit, A. Torres, J.A. Vazquez, J. Wauters, T. Calandra, E. Asperges, S. Tejada, C. Lebihan, I. Karaiskos, M. Peghin, K.L. Mortensen, A. Vena, A. Cortegiani, T. Mercier, the FUNDICU investigators

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)131-146
Number of pages16
JournalJ. Infect.
Volume81
Issue number1
DOIs
Publication statusPublished - 2020

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