Department of Pediatrics I, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
Department of Pediatrics III, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
BMC Pulm Med. 2019 Jul 18;19(1):132. doi: 10.1186/s12890-019-0894-7.
Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood.
The aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method.
We investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared.
Pathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125).
Compared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.
支气管肺泡灌洗（BAL）液培养是肺炎病原体检测的常用方法。然而，其敏感性较低，尤其是在接受抗感染治疗的患者中。早期检测病原体对于呼吸道感染的结局至关重要。对于血流感染，可采用多重聚合酶链反应（PCR）检测（SeptiFast ® ，SF）来提高血液病原体的检测率。
本研究旨在确定 SF 检测是否适用于患有肺部感染的儿童的 BAL 液，以及该多重 PCR 方法是否能提高病原体的检测频率。
我们同时对 70 名儿童的 70 份 BAL 样本进行培养和多重 PCR 检测，比较了病原体的检测频率。
SF 比培养法检测到的病原体更多（83% vs. 31%；p<0.001）。这种优势在免疫功能正常的患者（p=0.001）和免疫功能低下的患者中均可见（p=0.003）。大多数（38/44；86%）革兰阳性球菌仅通过 SF 检测到。SF 在 70 名患者中的 7 名（10%）和培养法中的 2 名（3%）（p=0.125）中检测到真菌。
与传统培养相比，SF 检测在儿童肺炎的 BAL 液中使用增加了病原体的检测率，从而为指导抗感染治疗提供了重要信息。
