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Implications for the diagnosis of aspiration and aspergillosis in critically ill patients with detection of galactomannan in broncho-alveolar lavage fluids

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 anal...

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Main Authors: Dubler, Simon (Author) , Etringer, Michael (Author) , Lichtenstern, Christoph (Author) , Brenner, Thorsten (Author) , Zimmermann, Stefan (Author) , Schnitzler, Paul (Author) , Budeus, Bettina (Author) , Rengier, Fabian (Author) , Kalinowska, Paulina (Author) , Hoo, Yuan Lih (Author) , Weigand, Markus A. (Author)
Format: Article (Journal)
Language:English
Published: 15 January 2025
In: Scientific reports
Year: 2025, Volume: 15, Pages: 1-10
ISSN:2045-2322
DOI:10.1038/s41598-025-85644-5
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1038/s41598-025-85644-5
Verlag, kostenfrei, Volltext: https://www.nature.com/articles/s41598-025-85644-5
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Author Notes:Simon Dubler, Michael Etringer, Christoph Lichtenstern, Thorsten Brenner, Stefan Zimmermann, Paul Schnitzler, Bettina Budeus, Fabian Rengier, Paulina Kalinowska, Yuan Lih Hoo & Markus A. Weigand
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Summary: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.
Item Description:Veröffentlicht: 15 Januar 2025
Gesehen am 04.08.2025
Physical Description:Online Resource
ISSN:2045-2322
DOI:10.1038/s41598-025-85644-5

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