Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids
Abstract Invasive infections with Aspergillus fumigatus in ICU patients are linked to high morbidity and mortality. Diagnosing invasive pulmonary aspergillosis (IPA) in non-immunosuppressed patients is difficult, as Aspergillus antigen (galactomannan [GM]) may have other causes. This retrospective s...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-025-85644-5 |
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| author | Simon Dubler Michael Etringer Christoph Lichtenstern Thorsten Brenner Stefan Zimmermann Paul Schnitzler Bettina Budeus Fabian Rengier Paulina Kalinowska Yuan Lih Hoo Markus A. Weigand |
| author_facet | Simon Dubler Michael Etringer Christoph Lichtenstern Thorsten Brenner Stefan Zimmermann Paul Schnitzler Bettina Budeus Fabian Rengier Paulina Kalinowska Yuan Lih Hoo Markus A. Weigand |
| author_sort | Simon Dubler |
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| description | Abstract Invasive infections with Aspergillus fumigatus in ICU patients are linked to high morbidity and mortality. Diagnosing invasive pulmonary aspergillosis (IPA) in non-immunosuppressed patients is difficult, as Aspergillus antigen (galactomannan [GM]) may have other causes. This retrospective study analyzed 160 ICU surgical patients with positive GM in broncho-alveolar lavage fluid (BALF), classifying them based on AspICU criteria for suspected IPA (pIPA) or aspiration. Patients with pIPA had higher disease severity than those with aspiration, including higher dialysis rates, organ transplantation, corticosteroid use, and Sequential Organ Failure Assessment (SOFA) score. Aspergillus culture was positive in 47.0% of pIPA cases but only 2.6% of aspiration cases (p < 0.001). SOFA score at first positive GM in BALF independently predicted 28-day mortality. In surgical patients with a positive GM in BALF, aspiration is more likely if there’s no corticosteroid therapy, negative Aspergillus culture, and a history of aspiration events. Diagnosis of pIPA requires Aspergillus culture or prior corticosteroid therapy in this cohort of critically ill patients. |
| format | Article |
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| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-3d92aadc41b94f64a2eea5fcb407b83e2025-01-19T12:19:34ZengNature PortfolioScientific Reports2045-23222025-01-0115111010.1038/s41598-025-85644-5Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluidsSimon Dubler0Michael Etringer1Christoph Lichtenstern2Thorsten Brenner3Stefan Zimmermann4Paul Schnitzler5Bettina Budeus6Fabian Rengier7Paulina Kalinowska8Yuan Lih Hoo9Markus A. Weigand10Department of Anesthesiology, Medical Faculty, Heidelberg UniversityDepartment of Anesthesiology, Medical Faculty, Heidelberg UniversityDepartment of Anesthesiology, Medical Faculty, Heidelberg UniversityDepartment of Anaesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg- EssenDivision Bacteriology, Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University HospitalDepartment of Infectious Diseases, Virology, Heidelberg University HospitalInstitute of Cell Biology (Cancer Research), University of Duisburg-EssenClinic for Diagnostic and Interventional Radiology, Heidelberg University HospitalClinic for Diagnostic and Interventional Radiology, Heidelberg University HospitalDepartment of Anesthesiology, Medical Faculty, Heidelberg UniversityDepartment of Anesthesiology, Medical Faculty, Heidelberg UniversityAbstract Invasive infections with Aspergillus fumigatus in ICU patients are linked to high morbidity and mortality. Diagnosing invasive pulmonary aspergillosis (IPA) in non-immunosuppressed patients is difficult, as Aspergillus antigen (galactomannan [GM]) may have other causes. This retrospective study analyzed 160 ICU surgical patients with positive GM in broncho-alveolar lavage fluid (BALF), classifying them based on AspICU criteria for suspected IPA (pIPA) or aspiration. Patients with pIPA had higher disease severity than those with aspiration, including higher dialysis rates, organ transplantation, corticosteroid use, and Sequential Organ Failure Assessment (SOFA) score. Aspergillus culture was positive in 47.0% of pIPA cases but only 2.6% of aspiration cases (p < 0.001). SOFA score at first positive GM in BALF independently predicted 28-day mortality. In surgical patients with a positive GM in BALF, aspiration is more likely if there’s no corticosteroid therapy, negative Aspergillus culture, and a history of aspiration events. Diagnosis of pIPA requires Aspergillus culture or prior corticosteroid therapy in this cohort of critically ill patients.https://doi.org/10.1038/s41598-025-85644-5AspergillosisAspergillus spp.Invasive pulmonary aspergillosisCritical illnessIntensive care unitPneumonia |
| spellingShingle | Simon Dubler Michael Etringer Christoph Lichtenstern Thorsten Brenner Stefan Zimmermann Paul Schnitzler Bettina Budeus Fabian Rengier Paulina Kalinowska Yuan Lih Hoo Markus A. Weigand Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids Scientific Reports Aspergillosis Aspergillus spp. Invasive pulmonary aspergillosis Critical illness Intensive care unit Pneumonia |
| title | Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids |
| title_full | Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids |
| title_fullStr | Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids |
| title_full_unstemmed | Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids |
| title_short | Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids |
| title_sort | implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho alveolar lavage fluids |
| topic | Aspergillosis Aspergillus spp. Invasive pulmonary aspergillosis Critical illness Intensive care unit Pneumonia |
| url | https://doi.org/10.1038/s41598-025-85644-5 |
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