Salina Anna, Schumann Desiree M, Franchetti Léo, Jahn Kathleen, Purkabiri Kurosch, Müller Raphael, Strobel Werner, Khanna Nina, Tamm Michael, Stolz Daiana
Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
Clinic of Infectiology and Hospital Hygiene, University Hospital Basel, Basel, Switzerland.
ERJ Open Res. 2022 Apr 25;8(2). doi: 10.1183/23120541.00595-2021. eCollection 2022 Apr.
Early pathogen identification in pulmonary infection is crucial to guide antibacterial therapy and decrease length of hospital stay. We hypothesise that compared to conventional diagnostic methods, a multiplex bacterial polymerase chain reaction assay has a higher diagnostic yield in bronchoalveolar lavage (BAL) fluid and improved clinical outcomes in patients with suspicion of pulmonary infection.
A prospective, monocentric, quasi-experimental, observational study was carried out. Unselected patients with suspected pulmonary infection who underwent bronchoscopy with BAL were included in the study over a period of 1 year. In addition to conventional diagnostic methods, a multiplex PCR bacterial assay was performed in BAL on a 2 week on: 1 week off pre-determined schedule. No therapeutic recommendations were provided to the treating physician.
605 cases were included, 54% of whom were immunosuppressed. Conventional diagnostic methods detected 56% of the bacteria evidenced by PCR. PCR failed to detect bacteria in 4% of the cases with a positive conventional diagnostic result. After bronchoscopy, 42% of the patients received antibacterial therapy for pulmonary infection for a median of 12 antibiotic days. There was no statistically significant difference in length of hospital stay (median 8 8; p=0.839), antibiotic exposure (median 11 14; p=0.362) or number of antibiotics prescribed (median 2 2; p=0.595) between the two groups.
A multiplex bacterial PCR detected more bacteria in BAL fluid than conventional diagnostic methods. However, without a specific antibiotic stewardship approach and a clear understanding of the clinical implications of a positive or negative PCR result, the PCR results did not influence clinical outcomes.
肺部感染的早期病原体鉴定对于指导抗菌治疗和缩短住院时间至关重要。我们假设，与传统诊断方法相比，多重细菌聚合酶链反应检测在支气管肺泡灌洗（BAL）液中的诊断率更高，并且对于疑似肺部感染的患者能改善临床结局。
开展了一项前瞻性、单中心、准实验性观察研究。在1年的时间里，纳入了未经过挑选的疑似肺部感染且接受BAL支气管镜检查的患者。除了传统诊断方法外，BAL样本按照预定的两周检测、一周休息的计划进行多重PCR细菌检测。未向治疗医生提供治疗建议。
共纳入605例患者，其中54%为免疫抑制患者。传统诊断方法检测出PCR证实的56%的细菌。在传统诊断结果为阳性的病例中，4%的病例PCR未能检测到细菌。支气管镜检查后，42%的患者因肺部感染接受了抗菌治疗，抗生素使用天数中位数为12天。两组患者在住院时间（中位数8天对8天；p=0.839）、抗生素暴露（中位数11天对14天；p=0.362）或开具的抗生素数量（中位数2种对2种；p=0.595）方面无统计学显著差异。
多重细菌PCR在BAL液中检测到的细菌比传统诊断方法更多。然而，在没有特定的抗生素管理方法以及对PCR阳性或阴性结果的临床意义缺乏清晰认识的情况下，PCR结果并未影响临床结局。
