Lateral Flow Device Routine Testing for Invasive Pulmonary Aspergillosis in Patients Who Are Critically Ill: A Multicenter Intensive Care Unit Cohort Study.

Background: The incidence of invasive pulmonary aspergillosis (IPA) is rising among intensive care unit (ICU) patients, with early diagnosis and treatment being critical for survival. Lateral flow assays for antigen detection have recently been introduced, enabling rapid results within an hour and potentially supporting earlier clinical decision making and timely antifungal therapy.

Methods: This retrospective multicenter study included 180 ICU patients, 48 with IPA and 132 controls, across 9 treatment centers. Fungal infections were classified according to the FUNDICU criteria (Invasive Fungal Diseases in Adult Patients in Intensive Care Unit).

Results: Among the 180 patients, 48 were classified as having probable IPA, while 132 exhibited host factors and radiologic findings consistent with IPA but did not meet the FUNDICU criteria. In this cohort, the sensitivity and specificity of the bronchoalveolar lavage lateral flow device test for diagnosing probable IPA vs no IPA were 71% (95% CI, 56%-83%) and 98% (94%-100%), respectively. The area under the receiver operating characteristic curve was 0.84, indicating good diagnostic performance. The positive and negative likelihood ratios were 31.17 (10.03-96.80) and 0.30 (.19-.46), yielding a diagnostic odds ratio of 104 (30-360). The positive and negative predictive values were 92% (78%-98%) and 90% (84%-95%).

Conclusions: Lateral flow device testing may serve as a valuable tool for the rapid diagnosis of IPA in time-critical ICU settings. However, it is not sufficient to definitively rule out the disease, and a comprehensive diagnostic approach remains essential.