Identifying Gaps in the International Consensus Case Definitions for Invasive Aspergillosis: A Review of Clinical Cases Not Meeting These Definitions

Tio, SY; Chen, SCA; Heath, CH; Pradhan, A; Morris, AJ; Korman, TM; Morrissey, CO; Halliday, CL; Kidd, S; Spelman, T; Brell, N; McMullan, B; Clark, JE; Mitsakos, K; Hardiman, RP; Williams, PCM; Campbell, AJ; Beardsley, J; Van Hal, S; Yong, MK; Worth, LJ; Slavin, MA

Author(s): Tio, SY; Chen, SCA; Heath, CH; Pradhan, A; Morris, AJ; Korman, TM; Morrissey, CO; Halliday, CL; Kidd, S; Spelman, T; Brell, N; McMullan, B; Clark, JE; Mitsakos, K; Hardiman, RP; Williams, PCM; Campbell, AJ; Beardsley, J; Van Hal, S; Yong, MK; Worth, LJ; Slavin, MA;
Details: Publication Year 2024-11,Volume 11,Issue #11,Page ofae594
Journal Title: Open Forum Infectious Diseases
Publication Type: Review
Abstract: BACKGROUND: International consensus definitions for invasive aspergillosis (IA) in research are rigorous, yet clinically significant cases are often excluded from clinical studies for not meeting proven/probable IA case definitions. To better understand reasons for the failure to meet criteria for proven/probable infection, we herein review 47 such cases for their clinical and microbiological characteristics and outcomes. METHODS: Data on 47 cases that did not meet consensus IA definitions but were deemed significant were derived from a retrospective, observational, multicenter survey of 382 presumed IA cases across Australasia, of which findings of 221 proven/probable infections were recently published. The clinical, microbiological, and radiologic characteristics of these cases were analyzed. Mortality outcomes were compared with those of 221 proven/probable cases. RESULTS: Of 47 cases studied, 15 lacked classical host factors; 22 exhibited only a single positive Aspergillus polymerase chain reaction result; 7 lacked typical IA radiologic findings on chest computed tomography; and 3 had borderline galactomannan optical density indices (<1.0 but ≥0.5) in bronchoalveolar lavage fluid. The median age of patients was 61 years (IQR, 52-68); 34 were male (72%). Seven patients (15%) required intensive care admission. All patients had lung as the primary site of infection. Antifungal treatment was initiated in 42 patients (89%). All-cause 90-day mortality was 33%, similar to the 30% mortality in the comparative cohort (n = 221). CONCLUSIONS: Our findings highlight the limitations of current consensus definitions for IA. Notably, the mortality of patients not meeting these definitions was similar to that of patients with proven/probable IA. Further studies, especially of patients with a single positive Aspergillus polymerase chain reaction result and those without host factors, are needed to determine if future consensus definitions may benefit from modifications.
Publisher: Oxford University Press
Keywords: host factors; invasive aspergillosis; mortality; not meeting EORTC-MSGERC; single positive Aspergillus PCR
Department(s): Infectious Diseases; Health Services Research
Publisher's Version: https://doi.org/10.1093/ofid/ofae594
Open Access at Publisher's Site: https://doi.org/10.1093/ofid/ofae594
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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