Mini-Bronchoalveolar Lavage for Diagnosing Coronavirus Disease 2019-Associated Invasive Pulmonary Aspergillosis

Manon C Vanbellinghen; Burak Atasever; Hans J I van der Spoel; Catherine C S Bouman; Josje Altenburg; Karin van Dijk

doi:10.1097/CCE.0000000000000601

Mini-Bronchoalveolar Lavage for Diagnosing Coronavirus Disease 2019-Associated Invasive Pulmonary Aspergillosis

Crit Care Explor. 2021 Dec 17;3(12):e0601. doi: 10.1097/CCE.0000000000000601. eCollection 2021 Dec.

Authors

Manon C Vanbellinghen¹, Burak Atasever², Hans J I van der Spoel³, Catherine C S Bouman³, Josje Altenburg², Karin van Dijk¹

Affiliations

¹ Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
² Department of Pulmonology, Amsterdam UMC, Amsterdam, The Netherlands.
³ Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands.

Abstract

To evaluate the yield of mini-bronchoalveolar lavage compared with that of directed bronchoalveolar lavage in critically ill patients with suspected coronavirus disease 2019-associated pulmonary aspergillosis.

Design: A retrospective cohort study.

Setting: The ICU of the Amsterdam University Medical Centers.

Patients: Patients with confirmed coronavirus disease 2019 screened for coronavirus disease 2019-associated pulmonary aspergillosis.

Interventions: Mini-bronchoalveolar lavage and/or directed bronchoalveolar lavage.

Measurements and main results: In total, 76 patients were included, 20 of whom underwent bronchoalveolar lavage, 40 mini-bronchoalveolar lavage, and 16 both mini-bronchoalveolar lavage and bronchoalveolar lavage. The percentage of samples with one or more positive Aspergillus detecting test (galactomannan, culture, polymerase chain reaction) did not differ significantly between bronchoalveolar lavage and mini-bronchoalveolar lavage (16.7% vs 21.4%). However, in mini-bronchoalveolar lavage samples, this was more frequently driven by a positive polymerase chain reaction than in bronchoalveolar lavage samples (17.9% vs 2.8%; p = 0.030). In 81% of patients (13/16) with both mini-bronchoalveolar lavage and bronchoalveolar lavage, the test results were in agreement. In 11 of 12 patients (92%) with first a negative mini-bronchoalveolar lavage, the subsequent bronchoalveolar lavage sample was also negative.

Conclusions: We found a similar percentage of positive test results in mini-bronchoalveolar lavage and bronchoalveolar lavage samples in patients with suspected coronavirus disease 2019-associated pulmonary aspergillosis. Our findings indicate that mini-bronchoalveolar lavage could be a useful tool for coronavirus disease 2019-associated pulmonary aspergillosis screening in ICU patients.

Keywords: aspergillosis; bronchoalveolar lavage; bronchoscopy; critical care; diagnosis; severe acute respiratory syndrome coronavirus 2.