Department of Medicine, Solna, Infectious Diseases Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden.
Eur J Clin Microbiol Infect Dis. 2019 Feb;38(2):297-304. doi: 10.1007/s10096-018-3426-0. Epub 2018 Dec 13.
The aim of this study was to use a 16S rDNA sequencing method in combination with conventional culture in patients with parapneumonic effusions (PPE) to evaluate the methods, study the microbiological spectrum, and examine the presence of bacteria within the different stages of PPE. Adults with community-acquired pneumonia (CAP) and PPE (n = 197) admitted to the Departments of Infectious Diseases at four hospitals in Stockholm County during 2011-2014 were prospectively studied. All patients underwent thoracentesis. Twenty-seven non-infectious pleural effusions were used as controls. The pleural samples were analyzed with culture, 16S rDNA sequencing, pH, glucose, and lactate dehydrogenase. Microbiological etiology was found in 99/197 (50%) of the patients with mixed infections in 20 cases. The most common pathogens were viridans streptococci (n = 37) and anaerobic bacteria (n = 40). Among the 152 patients with both methods performed, 26/152 (17%) and 94/152 (62%) had bacteria identified with culture and 16S rDNA sequencing respectively (p < 0.001). In 24/26 (92%) culture-positive cases, the same organism was identified by 16S rDNA. All controls were negative in both methods. Among the patients with complicated PPE and complete sampling, bacteria were found in 69/74 patients (93%), all detected with 16S rDNA sequencing, compared to 23/74 (31%) culture-positive samples (p < 0.001). Compared with culture, 16S rDNA sequencing substantially improved the microbiological yield, a microbiological diagnosis was achieved in almost all patients with complicated PPE, and the specificity seemed to be high. 16S rDNA sequencing should be used together with culture in patients with PPE to guide antibiotic therapy.
本研究旨在使用 16S rDNA 测序方法结合传统培养方法，评估方法，研究微生物谱，并检查不同阶段胸腔渗出液（PPE）中的细菌存在情况。2011 年至 2014 年期间，在斯德哥尔摩县四家医院的传染病科前瞻性研究了患有社区获得性肺炎（CAP）和 PPE（n=197）的成年人。所有患者均接受了胸腔穿刺术。27 例非感染性胸腔积液用作对照。使用培养，16S rDNA 测序，pH 值，葡萄糖和乳酸脱氢酶分析胸腔样本。在 197 例患者中有 99/197（50%）存在混合感染，其中 20 例存在混合感染。最常见的病原体是草绿色链球菌（n=37）和厌氧菌（n=40）。在进行了两种方法的 152 例患者中，分别有 26/152（17%）和 94/152（62%）通过培养和 16S rDNA 测序鉴定出细菌（p<0.001）。在 26 例培养阳性的病例中，16S rDNA 鉴定出相同的病原体。所有对照在两种方法中均为阴性。在伴有复杂 PPE 和完整采样的患者中，在 69/74 例患者（93%）中发现了细菌，均通过 16S rDNA 测序检测到，而 74 例培养阳性样本中仅 23/74（31%）（p<0.001）。与培养相比，16S rDNA 测序大大提高了微生物学产量，几乎所有患有复杂 PPE 的患者均获得了微生物学诊断，并且特异性似乎很高。在 PPE 患者中，应将 16S rDNA 测序与培养结合使用，以指导抗生素治疗。
