Galactomannan detection in bronchoalveolar lavage fluid and serum in critically ill adult liver transplant recipients on mechanical ventilation at risk for invasive aspergillosis
Abstract number: R2351
Barrado L., Cuétara M.S., Alvarez M.E., Catalán M., Montejo J.C., Pontón J., del Palacio A.
Objectives: To prospectively assess and compare the galactomannan (GM) diagnostic performance on bronchoalveolar lavage fluid (BALF) and serum samples in critically ill liver transplant recipients (LTR) at risk for invasive aspergillosis (IA). GM performance in BALF remains poorly defined as a diagnostic adjunct in LTR at risk for IA.
Methods: Conventional microbiologic methods, tissue biopsies and necropsies, with the assessment of risk factors, signs, symptoms and radiologic imaging were used for the diagnosis of IA as defined by the Pauw et al (Clin Infect Dis 2008; 46:1813). GM detection (cutoff above 0.500) in BALF and serum samples was performed at the discretion of the Intensive Care Unit clinical team. Patients were stratified in 3 groups (high, intermediate and low risk) as proposed by Hellinger et al (Liver Transpl 2005; 11:656).
Results: There were 5 and 7 patients in the low and high risk group respectively. 4 patients were colonized on respiratory samples with Aspergillus (1 A. terreus, 1 A. fumigatus, and 2 A. niger). A total of 36 GM serum and 12 BALF samples were performed for 12 LTR patients on mechanical ventilation at risk for IA. There was 1 proven disseminated IA. The sensitivity (S), specificity (SP), positive and negative predictive values (PPV and NPV) for GM on BALF were 100, 90.90, 50 and 100% respectively and in serum samples were 100, 100, 100 and 100% respectively.
Conclusions: In this small LTR cohort there was one false positive GM assay on BALF in a patient colonized with A. niger. GM detection appears to be a good diagnostic adjunct for IA on LTR with a suggestive clinical syndrome and high probability of IA. Further investigations including a larger number of patients are needed to establish the usefulness of the GM assay in LTR on mechanical ventilation at risk for IA.
Acknowledgments: This investigation was supported by grants Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Proyecto Investigacion PI 070134 (to MSC), PI 070107 (to A d P) and PI 070376 (to JP), grant IT-26407 of Departamento de Educacion, Universidades e Investigacion del Gobierno Vasco (to JP) and Saiotek from Departamento de Industria, Comercio y Turismo del Gobierno Vasco (to JP) and an Educational grant from Pfizer (to A d P) and Gilead Spain (to A d P).
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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