This overview of reviews (i.e., an umbrella review) is designed to reappraise the validity of systematic reviews (SRs) and meta-analyses related to the performance of Aspergillus PCR tests for the diagnosis of invasive aspergillosis in immunocompromised patients. The methodological quality of the SRs was assessed using the AMSTAR-2 checklist; the quality of the evidence (QOE) within each SR was appraised following the GRADE approach. Eight out of 12 SRs were evaluated for qualitative and quantitative assessment. Five SRs evaluated Aspergillus PCR on bronchoalveolar lavage fluid (BAL) and three on blood specimens. The eight SRs included 167 overlapping reports (59 evaluating PCR in blood specimens, and 108 in BAL), based on 107 individual primary studies (98 trials with a cohort design, and 19 with a case-control design). In BAL specimens, the mean sensitivity and specificity ranged from 0.57 to 0.91, and from 0.92 to 0.97, respectively (QOE: very low to low). In blood specimens (whole blood or serum), the mean sensitivity ranged from 0.57 to 0.84, and the mean specificity from 0.58 to 0.95 (QOE: low to moderate). Across studies, only a low proportion of AMSTAR-2 critical domains were unmet (1.8%), demonstrating a high quality of methodological assessment. Conclusions. Based on the overall methodological assessment of the reviews included, on average we can have high confidence in the quality of results generated by the SRs.

Central European Institute of Technology Masaryk University 60177 Brno Czech Republic

Department of Internal Medicine 2 University Hospital of Würzburg 97070 Würzburg Germany

Department of Laboratory Medicine Karolinska Institutet 17177 Stockholm Sweden

Discipline of Clinical Microbiology Trinity College Dublin St James's Hospital Campus LS9 7TF Dublin Ireland

European Aspergillus PCR Initiative Nijmegen The Netherlands

Fungal PCR Initiative 37100 Verona Italy

Inserm U1285 CNRS UMR 8576 UGSF CHU Lille Laboratoire de Parasitologie Mycologie University of Lille 59000 Lille France

Institute of Medical Sciences School of Medicine Medical Sciences and Nutrition University of Aberdeen Aberdeen AB24 3FX UK

Medicine Clinic 2 Caritas Hospital Bad Mergentheim 97980 Bad Mergentheim Germany

MRC Centre for Medical Mycology University of Exeter Exeter EX4 4QJ UK

Public Health Wales Microbiology Cardiff UK and Centre for Trials Research Division of Infection and Immunity Cardiff University Cardiff CF14 4XW UK

School of Medicine Cardiff University Cardiff CF10 3AT UK

School of Science Western Sydney University Campbelltown Campus Campbelltown NSW 2751 Australia

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