Is the covid-19 pandemic a good time to include aspergillus molecular detection to categorize aspergillosis in icu patients? A monocentric experience

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Abstract

(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU) remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated Aspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (Ι) Aspergillus PCR and culture in respiratory samples, and (ΙΙ) blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58 and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts.

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Gangneux, J. P., Reizine, F., Guegan, H., Pinceaux, K., Le Balch, P., Prat, E., … Robert-Gangneux, F. (2020). Is the covid-19 pandemic a good time to include aspergillus molecular detection to categorize aspergillosis in icu patients? A monocentric experience. Journal of Fungi, 6(3), 1–12. https://doi.org/10.3390/jof6030105

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