生物梅里埃肺炎检测 panel 在肺供体中的应用：更快的检测速度，但病原体有限。

Biofire pneumonia panel in lung donors: faster detection but limited pathogens.

机构信息

Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, California, USA.

Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA.

出版信息

Transpl Infect Dis. 2023 Aug;25(4):e14091. doi: 10.1111/tid.14091. Epub 2023 Jul 10.

DOI:10.1111/tid.14091

PMID:37428868

Abstract

BACKGROUND

Culture of bronchoalveolar lavage (BAL) specimens takes time to report. We tested whether a molecular diagnostic test could accelerate donor lung assessment and treatment.

METHODS

We compared BioFire Film Array Pneumonia Panel (BFPP) with standard of care (SOC) tests on lung allograft samples at three time points: (1) donor BAL at organ recovery, (2) donor bronchial tissue and airway swab at implantation, and (3) first recipient BAL following lung implantation. Primary outcomes were the difference in time to result (Wilcoxon signed-ranked tests) and the agreement in results between BFPP and SOC assays (Gwet's agreement coefficient).

RESULTS

We enrolled 50 subjects. In donor lung BAL specimens, BFPP detected 52 infections (14 out of 26 pathogens in the panel). Viral and bacterial BFPP results were reported 2.4 h (interquartile range, IQR 2.0-6.4) following BAL versus 4.6 h (IQR 1.9-6.0, p = 0.625) for OPO BAL viral SOC results and 66 h (IQR 47-87, p < .0001) for OPO BAL bacterial SOC results. Although there was high overall agreement of results between BAL-BFPP versus OPO BAL-SOC tests (Gwet's AC p < .001 for all), the level of agreement differed among 26 pathogens designed in BFPP and differed by types of specimens. BFPP could not detect many infections identified by SOC assays.

CONCLUSIONS

BFPP decreased time to detection of lung pathogens among donated lungs, but it cannot replace SOC tests due to the limited number of pathogens in the panel.

摘要

背景

支气管肺泡灌洗（BAL）标本的培养需要时间报告。我们测试了一种分子诊断测试是否可以加速供肺评估和治疗。

方法

我们比较了三种时间点的肺移植样本的生物消防薄膜阵列肺炎面板（BFPP）与标准护理（SOC）测试：（1）器官回收时的供体 BAL，（2）植入时的供体支气管组织和气道拭子，以及（3）肺移植后第一个受者 BAL。主要结果是结果时间的差异（Wilcoxon 符号秩检验）和 BFPP 与 SOC 检测之间结果的一致性（Gwet 一致性系数）。

结果

我们纳入了 50 名受试者。在供体肺 BAL 标本中，BFPP 检测到 52 种感染（面板中 14 种病原体中的 14 种）。病毒和细菌 BFPP 结果在 BAL 后 2.4 小时（四分位距，IQR 2.0-6.4）报告，而 OPO BAL 病毒 SOC 结果为 4.6 小时（IQR 1.9-6.0，p = 0.625），OPO BAL 细菌 SOC 结果为 66 小时（IQR 47-87，p <.0001）。尽管 BAL-BFPP 与 OPO BAL-SOC 检测之间的结果总体具有高度一致性（Gwet 的 AC 对于所有结果均<.001），但在 BFPP 设计的 26 种病原体之间存在一致性差异，并且在标本类型上存在差异。BFPP 无法检测到 SOC 检测确定的许多感染。