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Diagnostic utility of endotracheal aspirate galactomannan for invasive pulmonary aspergillosis in ICU patients
Ravi Kumar, Ankesh Gupta, Arvind Kumar, Sandeep Rao Kordcal, Upendra Baitha, Gagandeep Singh, Immaculata Xess, Karan Madan, Manish Soneja, Naveet Wig
The paper will appear in: Infez Med, September 2026
Published on the journal website: 20 June 2026 - Section: Original article
Abstract View article download
Abstract
Background: Invasive pulmonary aspergillosis (IPA) is a serious infection in critically ill patients. Galactomannan detection in endotracheal aspirates (ETA) has emerged as a promising non-invasive diagnostic method. This study evaluates the supportive diagnostic value of ETA galactomannan in ICU patients suspected to have IPA.
Methods: We conducted a prospective observational cohort study over two years, enrolling 120 patients in the medicine ICU at a tertiary care centre in India (January 2022 to October 2023). Patients aged over 14 years on mechanical ventilation for >48 hours meeting the entry criteria of the BM-AspICU algorithm were included. ETA galactomannan was measured and correlated with IPA classification.
Results: Of 120 patients, 37% (n=44) had probable IPA and 63% (n=76) were classified as colonisers or possible IPA. The optimal ETA galactomannan cut-off was 1.097, yielding sensitivity 72.73% (95% CI 57.2–85.0%), specificity 84.2% (95% CI 74.4–90.7%), PLR 4.86, NLR 0.35, and AUC 0.844
Conclusion: ETA galactomannan supports IPA diagnosis with favourable sensitivity and specificity. However, given the limitations of clinical scoring-based reference standards and the potential plateau in colonizer reduction at higher cut-offs, it should be integrated into a comprehensive diagnostic approach incorporating clinical, radiological, and microbiological criteria.