New clinical algorithm including fungal biomarkers to better diagnose probable invasive pulmonary aspergillosis in ICU

Autor: Jean-Christophe Navellou, Stéphane Bretagne, Gaël Piton, Laurence Millon, Joffrey Hamam, Emeline Scherer, Anne-Pauline Bellanger, Hadrien Winiszewski
Přispěvatelé: Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Libourne, Service de parasitologie et mycologie [CHRU de Besançon], Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Mycologie moléculaire - Molecular Mycology, Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), None, Members of the Collaborative RESSIF group: Eric Bailly (CHU de Tours, Tours, France), Anne Isabelle Bertozi (CHU de Toulouse, Toulouse, France), Julie Bonhomme (CHU Caen, Caen, France), Bernard Bouteille (CHU de Limoges, Limoges, France), Cedric Bretonnière (CHU de Nantes, Nantes, France), Sophie Cassaing (CHU de Toulouse, Toulouse, France), Taieb Chouaki (CHU Amiens, Amiens, France), Olivier Cointault (CHU de Toulouse, Toulouse, France), Pierre Delobel (CHU de Toulouse, Toulouse, France), Odile Eloy (CH de Versailles, Versailles, France), Stanislas Faguer (CHU de Toulouse, Toulouse, France), Jerome Guinard (CH Orléans, Orléans, France), Thierry Lepoivre (CHU de Nantes, Nantes, France), Valerie Letscher-Bru (CHU de Strasbourg, Strasbourg, France), Bertrand Marcheix (CHU de Toulouse, Toulouse, France), Alida Minoza (CHU de Poitiers, Poitiers, France), Florent Morio (CHU de Nantes, Nantes, France), Celine Nourisson (CHU Clermont-Ferrand, Clermont-Ferrand, France), André Paugam (CHU Cochin, Paris, France), Hélène Raberin (CHU St-Etienne, St Etienne, France), Beatrice Riu (CHU de Toulouse, Toulouse, France)., Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
medicine.medical_specialty
Population
Critical Care and Intensive Care Medicine
Aspergillosis
law.invention
03 medical and health sciences
0302 clinical medicine
law
[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases
Anesthesiology
Internal medicine
medicine
Aspergillus qPCR
Intensive care unit
030212 general & internal medicine
Prospective cohort study
education
skin and connective tissue diseases
Mycosis
Fungal biomarkers
education.field_of_study
business.industry
Research
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Cancer
lcsh:RC86-88.9
medicine.disease
3. Good health
respiratory tract diseases
Clinical algorithm
030228 respiratory system
Biomarker (medicine)
Invasive aspergillosis
Galactomannan antigen
[SDV.IB]Life Sciences [q-bio]/Bioengineering
business
Zdroj: Annals of Intensive Care
Annals of Intensive Care, 2021, 11 (1), pp.41. ⟨10.1186/s13613-021-00827-3⟩
Annals of Intensive Care, SpringerOpen, 2021, 11 (1), pp.41. ⟨10.1186/s13613-021-00827-3⟩
Annals of Intensive Care, Vol 11, Iss 1, Pp 1-9 (2021)
ISSN: 2110-5820
DOI: 10.1186/s13613-021-00827-3⟩
Popis: Background The classification of invasive pulmonary aspergillosis (IPA) issued by the European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) is used for immunocompromised patients. An alternative algorithm adapted to the intensive care unit (ICU) population has been proposed (AspICU), but this algorithm did not include microbial biomarkers such as the galactomannan antigen and the Aspergillus quantitative PCR. The objective of the present pilot study was to evaluate a new algorithm that includes fungal biomarkers (BM-AspICU) for the diagnosis of probable IPA in an ICU population. Patients and methods Data from 35 patients with pathology-proven IPA according to European Organization for the Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSGERC)-2008 criteria were extracted from the French multicenter database of the Invasive Fungal Infections Surveillance Network (RESSIF). The patients were investigated according to the AspICU algorithm, and the BM-AspICU algorithm in analyzing the clinical, imaging, and biomarker data available in the records, without taking into account the pathology findings. Results Eight patients had to be excluded because no imaging data were recorded in the database. Among the 27 proven IPAs with complete data, 16 would have been considered as putative IPA with the AspICU algorithm and 24 would have been considered as probable IPA using the new algorithm BM-AspICU. Seven out of the 8 patients with probable BM-AspICU IPA (and not classified with the AspICU algorithm) had no host factors and no Aspergillus-positive broncho-alveolar lavage fluid (BALF) culture. Three patients were non-classifiable with any of the two algorithms, because they did not have any microbial criteria during the course of the infection, and diagnosis of proven aspergillosis was done using autopsy samples. Conclusion Inclusion of biomarkers could be effective to identify probable IPA in the ICU population. A prospective study is needed to validate the routine application of the BM-AspICU algorithm in the ICU population.
Databáze: OpenAIRE
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