215. Diagnostic Value of PCR and Galactomannan for Invasive Pulmonary Aspergillosis in Bronchoalveolar Lavage Fluid Samples From Non-Neutropenic  Critically Ill Patients
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Critically ill patients are at particular risk for invasive pulmonary aspergillosis (IPA). Radiology, culture and microscopy have lower sensitivity and specificity for IPA. We aimed to determine the risk factors of IPA in non-neutropenic critically ill patients, and the diagnostic value of aspergillus PCR and galactomannan (GM) level.

Methods: Consecutive BAL and serum samples were obtained from all the patients with mechanical ventilated (MV) in the pulmonary intensive care unit (ICU) for four months in 2012. Aspergillus PCR was tested in BAL, and GM antigen was tested in both serum and BAL. To interpret the results, EORTC/MSG criteria for invasive fungal disease were used. Reciever operating characteristics (ROC) is used to determine the diagnostic values of BAL aspergillus PCR and BAL GM.

Results: The incidence rate of IPA was 11,4% in a total of 44 patients. In probable IPA patients, BAL GM levels were higher than non-IPA patients (p<0,05). The prolonged duration in ICU, septic shock and high doses (>460 mg) of prednisolon were found to be risk factors for IPA. An optical density ratio of 0,7 was yielded as the cut-off for GM in BAL. Sensitivities of GM in serum and PCR in BAL were very low (Table 1).

Table 1. The Sensitivity, Specificity, and Positive and Negative Predictive Values of GM in BAL and serum, and PCR in BAL

Test

Cut-off

Sensitivity

Specificity

PPV

NPV

 

 

(%)

GM in BAL

≥0,5

100

(47,9-100)

78,8

(61,0-90,9)

41,6

(15,3-72,2)

100

(86,6-100)

 

≥0,7

100

(47,9-100)

87,9

(71,7-96,5)

55,5

(21,4-86,0)

100

(87,9-100)

 

≥0,8

80,0

(33,1-98,9)

90,9

(83,8-93,8)

57,1

(23,6-70,7)

96,8

889,2-99,8)

 

≥1,0

80,0

(28,8-96,7)

90,9

(75,6-97,9)

57,1

(18,7-89,5)

96,7

(83,2-99,4)

GM in serum

 

≥1,0

33,3

(4,9-36,8)

97,1

(92,1-99,8)

66,7

(13,0-98,2)

89,5

(80,0-86,7)

PCR in BAL

40,0

(7,8-71,4)

       93,9

(89,1-98,7)

50,0

(9,7-89,3)

91,2

(86,4-95,8)

Conclusion: The incidence of IPA was found higher than expected. This should be confirmed with further studies. It should be suspected from IPA in patients stayed longer duration in ICU and received high dose steroid. Galactomannan assay on BAL yielded highly accurate results for diagnosis of IPA in non-neutropenic ICU patients.

Selcuk Ozger1, Kenan Hizel2, Ayse Kalkanci3, Muge Aydogdu4, Fusun Civil, MD5, Murat Dizbay2 and Gul Gursel4, (1)Infectious Diseases, Gazi University School of Medicine, ANKARA, Turkey, (2)Infectious Diseases, Gazi University School Of Medicine, ANKARA, Turkey, (3)Clinical Microbiology, Gazi University School Of Medicine, ANKARA, Turkey, (4)Pulmonary Medicine, Gazi University School Of Medicine, ANKARA, Turkey, (5)Public Health, Gazi University Medical School, ANKARA, Turkey

Disclosures:

S. Ozger, None

K. Hizel, None

A. Kalkanci, None

M. Aydogdu, None

F. Civil, None

M. Dizbay, None

G. Gursel, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.