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DOI: 10.1055/s-0043-1778137
Severe Community-Acquired Pneumonia in Immunocompromised Patients
Abstract
Due to higher survival rates with good quality of life, related to new treatments in the fields of oncology, hematology, and transplantation, the number of immunocompromised patients is increasing. But these patients are at high risk of intensive care unit admission because of numerous complications. Acute respiratory failure due to severe community-acquired pneumonia is one of the leading causes of admission. In this setting, the need for invasive mechanical ventilation is up to 60%, associated with a high hospital mortality rate of around 40 to 50%. A wide range of pathogens according to the reason of immunosuppression is associated with severe pneumonia in those patients: documented bacterial pneumonia represents a third of cases, viral and fungal pneumonia both account for up to 15% of cases. For patients with an undetermined etiology despite comprehensive diagnostic workup, the hospital mortality rate is very high. Thus, a standardized diagnosis strategy should be defined to increase the diagnosis rate and prescribe the appropriate treatment. This review focuses on the benefit-to-risk ratio of invasive or noninvasive strategies, in the era of omics, for the management of critically ill immunocompromised patients with severe pneumonia in terms of diagnosis and oxygenation.
Publikationsverlauf
Artikel online veröffentlicht:
24. Januar 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
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References
- 1 Harpaz R, Dahl RM, Dooling KL. Prevalence of immunosuppression among US adults, 2013. JAMA 2016; 316 (23) 2547-2548
- 2 Baeuerle PA, Reinhardt C. Bispecific T-cell engaging antibodies for cancer therapy. Cancer Res 2009; 69 (12) 4941-4944
- 3 Larson RC, Maus MV. Recent advances and discoveries in the mechanisms and functions of CAR T cells. Nat Rev Cancer 2021; 21 (03) 145-161
- 4 Mokart D, Pastores SM, Darmon M. Has survival increased in cancer patients admitted to the ICU? Yes. Intensive Care Med 2014; 40 (10) 1570-1572
- 5 Darmon M, Bourmaud A, Georges Q. et al. Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 2019; 45 (07) 977-987
- 6 Zampieri FG, Romano TG, Salluh JIF. Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study. Intensive Care Med 2021; 47 (02) 170-179
- 7 Lengliné E, Raffoux E, Lemiale V. et al. Intensive care unit management of patients with newly diagnosed acute myeloid leukemia with no organ failure. Leuk Lymphoma 2012; 53 (07) 1352-1359
- 8 Mokart D, Lambert J, Schnell D. et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma 2013; 54 (08) 1724-1729
- 9 Azoulay E, Mokart D, Pène F. et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol 2013; 31 (22) 2810-2818
- 10 Esteban A, Frutos-Vivar F, Muriel A. et al. Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188 (02) 220-230
- 11 Dumas G, Lemiale V, Rathi N. et al. Survival in immunocompromised patients ultimately requiring invasive mechanical ventilation: a pooled individual patient data analysis. Am J Respir Crit Care Med 2021; 204 (02) 187-196
- 12 Azoulay E, Russell L, Van de Louw A. et al; Nine-i Investigators. Diagnosis of severe respiratory infections in immunocompromised patients. Intensive Care Med 2020; 46 (02) 298-314
- 13 Di Pasquale MF, Sotgiu G, Gramegna A. et al; GLIMP Investigators. Prevalence and etiology of community-acquired pneumonia in immunocompromised patients. Clin Infect Dis 2019; 68 (09) 1482-1493
- 14 Sousa D, Justo I, Domínguez A. et al. Community-acquired pneumonia in immunocompromised older patients: incidence, causative organisms and outcome. Clin Microbiol Infect 2013; 19 (02) 187-192
- 15 Azoulay E, Pickkers P, Soares M. et al; Efraim investigators and the Nine-I study group. Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 2017; 43 (12) 1808-1819
- 16 Contejean A, Lemiale V, Resche-Rigon M. et al. Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology: a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study. Ann Intensive Care 2016; 6 (01) 102
- 17 Moreau A-S, Lengline E, Seguin A. et al. Respiratory events at the earliest phase of acute myeloid leukemia. Leuk Lymphoma 2014; 55 (11) 2556-2563
- 18 Bauer PR, Chevret S, Yadav H. et al; Efraim investigators and the Nine-I study group. Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy. Eur Respir J 2019; 54 (01) 1802442
- 19 Azoulay E, Mokart D, Lambert J. et al. Diagnostic strategy for hematology and oncology patients with acute respiratory failure: randomized controlled trial. Am J Respir Crit Care Med 2010; 182 (08) 1038-1046
- 20 Azoulay E, Schlemmer B. Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 2006; 32 (06) 808-822
- 21 Kamel T, Helms J, Janssen-Langenstein R. et al; Clinical Research in Intensive Care Sepsis Group (CRICS-TRIGGERSEP). Benefit-to-risk balance of bronchoalveolar lavage in the critically ill. A prospective, multicenter cohort study. Intensive Care Med 2020; 46 (03) 463-474
- 22 Legoff J, Zucman N, Lemiale V. et al. Clinical significance of upper airway virus detection in critically ill hematology patients. Am J Respir Crit Care Med 2019; 199 (04) 518-528
- 23 Azoulay E, Mokart D, Kouatchet A, Demoule A, Lemiale V. Acute respiratory failure in immunocompromised adults. Lancet Respir Med 2019; 7 (02) 173-186
- 24 Azadeh N, Sakata KK, Saeed A. et al. Comparison of respiratory pathogen detection in upper versus lower respiratory tract samples using the BioFire FilmArray respiratory panel in the immunocompromised host. Can Respir J 2018; 2018: 2685723
- 25 Affolter K, Schumann DM, Tamm M. et al. Multiplex PCR on the bronchoalveolar lavage fluid of immunocompromised patients. Chest 2018; 154 (03) 722-725
- 26 Azar MM, Schlaberg R, Malinis MF. et al. Added diagnostic utility of clinical metagenomics for the diagnosis of pneumonia in immunocompromised adults. Chest 2021; 159 (04) 1356-1371
- 27 Mahle RE, Suchindran S, Henao R. et al. Validation of a host gene expression test for bacterial/viral discrimination in immunocompromised hosts. Clin Infect Dis 2021; 73 (04) 605-613
- 28 Hilbert G, Gruson D, Vargas F. et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001; 344 (07) 481-487
- 29 Antonelli M, Conti G, Bufi M. et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 2000; 283 (02) 235-241
- 30 Frat J-P, Ragot S, Girault C. et al; REVA network. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. Lancet Respir Med 2016; 4 (08) 646-652
- 31 Lemiale V, Mokart D, Resche-Rigon M. et al; Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH). Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA 2015; 314 (16) 1711-1719
- 32 Lemiale V, Resche-Rigon M, Mokart D. et al. High-flow nasal cannula oxygenation in immunocompromised patients with acute hypoxemic respiratory failure: a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. Crit Care Med 2017; 45 (03) e274-e280
- 33 Azoulay E, Lemiale V, Mokart D. et al. Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: the HIGH randomized clinical trial. JAMA 2018; 320 (20) 2099-2107
- 34 Coudroy R, Frat JP, Ehrmann S. et al; FLORALI-IM study group and the REVA Research Network. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial. Lancet Respir Med 2022; 10 (07) 641-649
- 35 Cheng L-C, Chang SP, Wang JJ, Hsiao SY, Lai CC, Chao CM. The impact of high-flow nasal cannula on the outcome of immunocompromised patients with acute respiratory failure: a systematic review and meta-analysis. Medicina (Kaunas) 2019; 55 (10) 693
- 36 Wang Y, Ni Y, Sun J, Liang Z. Use of high-flow nasal cannula for immunocompromise and acute respiratory failure: a systematic review and meta-analysis. J Emerg Med 2020; 58 (03) 413-423
- 37 Ferreyro BL, Angriman F, Munshi L. et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA 2020; 324 (01) 57-67
- 38 Clouzeau B, Bui HN, Guilhon E. et al. Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients. Intensive Care Med 2011; 37 (12) 1969-1975
- 39 Antonelli M, Conti G, Riccioni L, Meduri GU. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 1996; 110 (03) 724-728
- 40 Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy—a prospective randomised trial. Crit Care 2014; 18 (06) 712
- 41 Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999; 115 (02) 462-474
- 42 Daniel P, Rodrigo C, Mckeever TM, Woodhead M, Welham S, Lim WS. British Thoracic Society. Time to first antibiotic and mortality in adults hospitalised with community-acquired pneumonia: a matched-propensity analysis. Thorax 2016; 71 (06) 568-570
- 43 Kreitmann L, Vasseur M, Jermoumi S. et al. Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med 2023; 49 (02) 154-165
- 44 Shindo Y, Ito R, Kobayashi D. et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013; 188 (08) 985-995
- 45 Ramirez JA, Musher DM, Evans SE. et al. Treatment of community-acquired pneumonia in immunocompromised adults: a consensus statement regarding initial strategies. Chest 2020; 158 (05) 1896-1911
- 46 Metlay JP, Waterer GW, Long AC. et al. Diagnosis and treatment of adults with community-acquired pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019; 200 (07) e45-e67
- 47 Prina E. et al. Risk factors associated with potentially antibiotic-resistant pathogens in community-acquired pneumonia. Ann Am Thorac Soc 12 2015; 153-160
- 48 Maruyama T, Fujisawa T, Ishida T. et al. A therapeutic strategy for all pneumonia patients: a 3-year prospective multicenter cohort study using risk factors for multidrug-resistant pathogens to select initial empiric therapy. Clin Infect Dis 2019; 68 (07) 1080-1088
- 49 Monard C, Pehlivan J, Auger G. et al; ADAPT study group. Multicenter evaluation of a syndromic rapid multiplex PCR test for early adaptation of antimicrobial therapy in adult patients with pneumonia. Crit Care 2020; 24 (01) 434
- 50 Serigstad S, Markussen D, Grewal HMS. et al; CAPNOR Study Group. Rapid syndromic PCR testing in patients with respiratory tract infections reduces time to results and improves microbial yield. Sci Rep 2022; 12 (01) 326
- 51 Gadsby NJ, Russell CD, McHugh MP. et al. Comprehensive molecular testing for respiratory pathogens in community-acquired pneumonia. Clin Infect Dis 2016; 62 (07) 817-823
- 52 Azoulay E, Roux A, Vincent F. et al. A multivariable prediction model for Pneumocystis jirovecii pneumonia in hematology patients with acute respiratory failure. Am J Respir Crit Care Med 2018; 198 (12) 1519-1526
- 53 Thomas Jr CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004; 350 (24) 2487-2498
- 54 Herbrecht R, Denning DW, Patterson TF. et al; Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347 (06) 408-415
- 55 Skiada A, Pagano L, Groll A. et al; European Confederation of Medical Mycology Working Group on Zygomycosis. Zygomycosis in Europe: analysis of 230 cases accrued by the registry of the European Confederation of Medical Mycology (ECMM) Working Group on Zygomycosis between 2005 and 2007. Clin Microbiol Infect 2011; 17 (12) 1859-1867
- 56 Cornely OA, Alastruey-Izquierdo A, Arenz D. et al; Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19 (12) e405-e421
- 57 Lanternier F, Poiree S, Elie C. et al; French Mycosis Study Group. Prospective pilot study of high-dose (10 mg/kg/day) liposomal amphotericin B (L-AMB) for the initial treatment of mucormycosis. J Antimicrob Chemother 2015; 70 (11) 3116-3123
- 58 Marty FM, Ostrosky-Zeichner L, Cornely OA. et al; VITAL and FungiScope Mucormycosis Investigators. Isavuconazole treatment for mucormycosis: a single-arm open-label trial and case-control analysis. Lancet Infect Dis 2016; 16 (07) 828-837
- 59 van Kraaij MGJ, van Elden LJ, van Loon AM. et al. Frequent detection of respiratory viruses in adult recipients of stem cell transplants with the use of real-time polymerase chain reaction, compared with viral culture. Clin Infect Dis 2005; 40 (05) 662-669
- 60 Collins JP, Campbell AP, Openo K. et al. Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015. Clin Infect Dis 2020; 70 (10) 2121-2130
- 61 Kim Y-J, Boeckh M, Englund JA. Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med 2007; 28 (02) 222-242
- 62 Khanna N, Widmer AF, Decker M. et al. Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature. Clin Infect Dis 2008; 46 (03) 402-412
- 63 Schnell D, Legoff J, Mariotte E. et al. Molecular detection of respiratory viruses in immunocopromised ICU patients: incidence and meaning. Respir Med 2012; 106 (08) 1184-1191
- 64 Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. Lancet 2015; 385 (9979) 1729-1737
- 65 Kanj SS, Sharara AI, Clavien PA, Hamilton JD. Cytomegalovirus infection following liver transplantation: review of the literature. Clin Infect Dis 1996; 22 (03) 537-549
- 66 Fisher RA. Cytomegalovirus infection and disease in the new era of immunosuppression following solid organ transplantation. Transpl Infect Dis 2009; 11 (03) 195-202
- 67 de Maar EF, Verschuuren EA, Harmsen MC, The TH, van Son WJ. Pulmonary involvement during cytomegalovirus infection in immunosuppressed patients. Transpl Infect Dis 2003; 5 (03) 112-120
- 68 Ljungman P, Boeckh M, Hirsch HH. et al; Disease Definitions Working Group of the Cytomegalovirus Drug Development Forum. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clin Infect Dis 2017; 64 (01) 87-91
- 69 Tamm M, Traenkle P, Grilli B. et al. Pulmonary cytomegalovirus infection in immunocompromised patients. Chest 2001; 119 (03) 838-843
- 70 Kotton CN, Kumar D, Caliendo AM. et al; The Transplantation Society International CMV Consensus Group. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 2018; 102 (06) 900-931
- 71 Roberts MB, Fishman JA. Immunosuppressive agents and infectious risk in transplantation: managing the “net state of immunosuppression”. Clin Infect Dis 2021; 73 (07) e1302-e1317
- 72 Asberg A, Jardine AG, Bignamini AA. et al; VICTOR Study Group. Effects of the intensity of immunosuppressive therapy on outcome of treatment for CMV disease in organ transplant recipients. Am J Transplant 2010; 10 (08) 1881-1888
- 73 Narayanan S, Banerjee C, Holt PA. Cryptococcal immune reconstitution syndrome during steroid withdrawal treated with hydroxychloroquine. Int J Infect Dis 2011; 15 (01) e70-e73
- 74 Singh N, Dromer F, Perfect JR, Lortholary O. Cryptococcosis in solid organ transplant recipients: current state of the science. Clin Infect Dis 2008; 47 (10) 1321-1327
- 75 Meintjes G, Stek C, Blumenthal L. et al; PredART Trial Team. Prednisone for the prevention of paradoxical tuberculosis-associated IRIS. N Engl J Med 2018; 379 (20) 1915-1925
- 76 Bige N, Zafrani L, Lambert J. et al. Severe infections requiring intensive care unit admission in kidney transplant recipients: impact on graft outcome. Transpl Infect Dis 2014; 16 (04) 588-596
- 77 Sileri P, Pursell KJ, Coady NT. et al. A standardized protocol for the treatment of severe pneumonia in kidney transplant recipients. Clin Transplant 2002; 16 (06) 450-454
- 78 Canet E, Zafrani L, Lambert J. et al. Acute kidney injury in patients with newly diagnosed high-grade hematological malignancies: impact on remission and survival. PLoS One 2013; 8 (02) e55870
- 79 Yang C-Y, Shih C-J, Yang W-C, Lin C-C. Aggressive immunosuppressant reduction and long-term rejection risk in renal transplant recipients with Pneumocystis jiroveci pneumonia. Exp Clin Transplant 2012; 10 (04) 344-349
- 80 Shih CJ, Tarng DC, Yang WC, Yang CY. Immunosuppressant dose reduction and long-term rejection risk in renal transplant recipients with severe bacterial pneumonia. Singapore Med J 2014; 55 (07) 372-377
- 81 Santeusanio AD, Menon MC, Liu C. et al. Influence of patient characteristics and immunosuppressant management on mortality in kidney transplant recipients hospitalized with coronavirus disease 2019 (COVID-19). Clin Transplant 2021; 35 (04) e14221
- 82 Dequin P-F, Meziani F, Quenot JP. et al; CRICS-TriGGERSep Network. Hydrocortisone in severe community-acquired pneumonia. N Engl J Med 2023; 388 (21) 1931-1941
- 83 Pareja JG, Garland R, Koziel H. Use of adjunctive corticosteroids in severe adult non-HIV Pneumocystis carinii pneumonia. Chest 1998; 113 (05) 1215-1224
- 84 Moon SM, Kim T, Sung H. et al. Outcomes of moderate-to-severe Pneumocystis pneumonia treated with adjunctive steroid in non-HIV-infected patients. Antimicrob Agents Chemother 2011; 55 (10) 4613-4618
- 85 Wieruszewski PM, Barreto JN, Frazee E. et al. Early corticosteroids for Pneumocystis pneumonia in adults without HIV are not associated with better outcome. Chest 2018; 154 (03) 636-644
- 86 Lemiale V, Debrumetz A, Delannoy A, Alberti C, Azoulay E. Adjunctive steroid in HIV-negative patients with severe Pneumocystis pneumonia. Respir Res 2013; 14 (01) 87
- 87 Karlin L, Darmon M, Thiéry G. et al. Respiratory status deterioration during G-CSF-induced neutropenia recovery. Bone Marrow Transplant 2005; 36 (03) 245-250
- 88 Azoulay E, Darmon M. Acute respiratory distress syndrome during neutropenia recovery. Crit Care 2010; 14 (01) 114
- 89 Mignard X, Biard L, Lemiale V. et al. Granulocyte colony-stimulating factor and respiratory status of critically ill neutropenic patients with hematologic malignancies. Leuk Lymphoma 2019; 60 (05) 1156-1163
- 90 Rañó A, Agustí C, Jimenez P. et al. Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures. Thorax 2001; 56 (05) 379-387
- 91 Danés C, González-Martín J, Pumarola T. et al. Pulmonary infiltrates in immunosuppressed patients: analysis of a diagnostic protocol. J Clin Microbiol 2002; 40 (06) 2134-2140
- 92 Azoulay E, Mokart D, Rabbat A. et al. Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data. Crit Care Med 2008; 36 (01) 100-107
- 93 Jorge L, Torres D, Languasco A. et al. Clinical usefulness of bronchoalveolar lavage in the management of pulmonary infiltrates in adults with hematological malignancies and stem cell transplantation. Mediterr J Hematol Infect Dis 2020; 12 (01) e2020025
- 94 Del Corpo O, Butler-Laporte G, Sheppard DC, Cheng MP, McDonald EG, Lee TC. Diagnostic accuracy of serum (1-3)-β-D-glucan for Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis. Clin Microbiol Infect 2020; 26 (09) 1137-1143
- 95 Senécal J, Smyth E, Del Corpo O. et al. Non-invasive diagnosis of Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis. Clin Microbiol Infect 2022; 28 (01) 23-30
- 96 Fan L-C, Lu H-W, Cheng K-B, Li H-P, Xu J-F. Evaluation of PCR in bronchoalveolar lavage fluid for diagnosis of Pneumocystis jirovecii pneumonia: a bivariate meta-analysis and systematic review. PLoS One 2013; 8 (09) e73099
- 97 Maertens JA, Raad II, Marr KA. et al. Isavuconazole versus voriconazole for primary treatment of invasive mould disease caused by Aspergillus and other filamentous fungi (SECURE): a phase 3, randomised-controlled, non-inferiority trial. Lancet 2016; 387 (10020): 760-769
- 98 Hoenigl M, Prattes J, Spiess B. et al. Performance of galactomannan, beta-d-glucan, Aspergillus lateral-flow device, conventional culture, and PCR tests with bronchoalveolar lavage fluid for diagnosis of invasive pulmonary aspergillosis. J Clin Microbiol 2014; 52 (06) 2039-2045
- 99 White PL, Wingard JR, Bretagne S. et al. Aspergillus polymerase chain reaction: systematic review of evidence for clinical use in comparison with antigen testing. Clin Infect Dis 2015; 61 (08) 1293-1303
- 100 de Heer K, Gerritsen MG, Visser CE, Leeflang MM. Galactomannan detection in broncho-alveolar lavage fluid for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2019; 5 (05) CD012399
- 101 Leeflang MMG, Debets-Ossenkopp YJ, Wang J. et al. Galactomannan detection for invasive aspergillosis in immunocompromised patients. Cochrane Database Syst Rev 2015; 2015 (12) CD007394