Division of Infection, Barts Health NHS Trust, London, UK.
Queen Mary's College, University of London, London, UK.
J Med Microbiol. 2021 May;70(5). doi: 10.1099/jmm.0.001366.
Pleural infections cause major morbidity and mortality, particularly amongst paediatric and elderly populations. The aetiology is broad, but pleural culture fails to yield a causative pathogen in approximately 40 % of cases. Alternative pathogen identification methods are therefore required. The aim of the study was to investigate the yield from and impact on patient care when performing 16S rRNA PCR on culture-negative pleural fluid specimens and to determine whether any individual laboratory parameters were associated with a positive 16S rRNA PCR result. We conducted a study on 90 patients with suspected pleural infection, who had a culture-negative pleural fluid specimen, which underwent 16S rRNA PCR analysis between August 2017 and June 2019. This study was undertaken at a large NHS Trust in London, UK. Thirty-one per cent of culture-negative pleural fluid specimens tested by 16S rRNA PCR yielded a positive PCR result. Our data demonstrated that 16S rRNA PCR detected a significantly higher proportion of (<0.0001) and fastidious, slow-growing and anaerobic pathogens (=0.0025) compared with culture-based methods. Of the 25 16S rRNA PCR results that were positive for a causative pathogen, 76 % had a direct impact on clinical management. No single laboratory variable was found to be associated with a positive 16S rRNA PCR result. The findings from our real-world evaluation highlight the importance of 16S rRNA PCR in confirming pleural infection when the aetiology is unknown, and its direct, positive impact on clinical management.
胸膜感染会导致重大发病率和死亡率，尤其是在儿科和老年人群中。病因广泛，但大约 40%的病例胸膜培养未能产生致病病原体。因此，需要替代的病原体鉴定方法。本研究旨在探讨在培养阴性的胸腔积液标本中进行 16S rRNA PCR 的检出率及其对患者治疗的影响，并确定任何个体实验室参数是否与 16S rRNA PCR 阳性结果相关。我们对 90 例疑似胸膜感染的患者进行了一项研究，这些患者的胸腔积液标本培养为阴性，并在 2017 年 8 月至 2019 年 6 月期间进行了 16S rRNA PCR 分析。这项研究是在英国伦敦的一家大型 NHS 信托基金中进行的。31%的 16S rRNA PCR 检测培养阴性的胸腔积液标本产生了阳性 PCR 结果。我们的数据表明，与基于培养的方法相比，16S rRNA PCR 检测到了更高比例的(<0.0001)和难培养、生长缓慢和厌氧病原体(=0.0025)。在 25 个 16S rRNA PCR 结果阳性的致病病原体中，76%直接影响临床管理。没有发现单个实验室变量与 16S rRNA PCR 阳性结果相关。我们的真实世界评估结果强调了 16S rRNA PCR 在确认病因不明的胸膜感染时的重要性，以及它对临床管理的直接、积极影响。
