Emergency Care Clinic, Haukeland University Hospital , Bergen, Norway.
Department of Clinical Medicine, University of Bergen , Bergen, Norway.
J Clin Microbiol. 2023 Sep 21;61(9):e0050523. doi: 10.1128/jcm.00505-23. Epub 2023 Aug 16.
Syndromic PCR-based analysis of lower respiratory tract (LRT) samples in patients with community-acquired pneumonia (CAP) improves the bacterial yield and time-to-results compared to culture-based methods. However, obtaining adequate sputum samples can be challenging and is frequently not prioritized in the emergency department (ED). In this study, we assess the concordance of microbiological detections between oropharyngeal- (OP) and LRT samples from patients presenting to the ED with CAP using a syndromic PCR-based respiratory panel [Biofire FilmArray Pneumonia (FAP )]. Paired OP- and high-quality LRT samples were collected from 103 patients with confirmed CAP, who had been included in a randomized controlled trial (NCT04660084) or a subsequent observational study at Haukeland University Hospital, and analyzed using the FAP . The LRT samples were obtained mainly by sputum induction (88%). Using the LRT samples as a reference standard, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement for the most common bacterial pathogens in CAP, and , were 85%, 99% and 95%, and 86%, 98% and 93%, respectively. For the PPA was lower (74%), while the NPA was 100%. For bacteria that are less likely causes of uncomplicated CAP (e.g., and Enterobacterales) the results were more divergent. In conclusion, the FAP detects the most common CAP pathogens and from OP samples with high PPAs and excellent NPAs when compared with LRT samples. For these pathogens, the PPAs for OP samples were higher than previous reports for nasopharyngeal samples. This suggests that analysis of OP samples with syndromic PCR panels could represent an alternative approach for rapid microbiological testing in the ED, especially in patients where LRT samples are difficult to obtain. Divergent results for bacteria that are less likely to cause uncomplicated CAP do, however, emphasize the need for clinical evaluation of positive test results.
基于综合征的聚合酶链反应（PCR）分析下呼吸道（LRT）样本可提高细菌性产量和结果得出时间，与基于培养的方法相比。然而，获得足够的痰样本可能具有挑战性，并且在急诊科（ED）中通常未被优先考虑。在这项研究中，我们使用基于综合征的聚合酶链反应呼吸道检测试剂盒[生物火 FilmArray 肺炎（FAP）]评估了急诊科 CAP 患者的口咽（OP）和 LRT 样本的微生物检测之间的一致性。103 例确诊 CAP 患者接受了随机对照试验（NCT04660084）或随后在豪克兰大学医院进行的观察性研究，从这些患者中收集了配对的 OP 和高质量的 LRT 样本，并使用 FAP 进行了分析。LRT 样本主要通过痰诱导获得（88%）。使用 LRT 样本作为参考标准，CAP 中最常见的细菌病原体和的阳性百分率一致性（PPA）、阴性百分率一致性（NPA）和总体百分率一致性分别为 85%、99%和 95%，86%、98%和 93%。对于，则 PPA 较低（74%），而 NPA 为 100%。对于不太可能引起单纯性 CAP 的细菌（例如和肠杆菌科），结果更为不一致。总之，FAP 从 OP 样本中检测到 CAP 最常见的病原体和，PPA 高，NPA 优异，与 LRT 样本相比。对于这些病原体，OP 样本的 PPA 高于以前报道的鼻咽样本。这表明，使用综合征 PCR 检测试剂盒分析 OP 样本可能是 ED 中快速微生物检测的替代方法，尤其是在 LRT 样本难以获得的患者中。然而，对于不太可能引起单纯性 CAP 的细菌的不一致结果确实强调了需要对阳性检测结果进行临床评估。
