Cano Sofía, de Michelena Paula, Clari Mª Ángeles, Liñan Jorge, Olea Beatriz, Torres Ignacio, Carbonell Nieves, Navarro David
Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Av. Blasco Ibáñez 17, Valencia, 46010, Spain.
Medical Intensive Care Unit, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain.
Eur J Clin Microbiol Infect Dis. 2025 Jan;44(1):27-35. doi: 10.1007/s10096-024-04967-9. Epub 2024 Oct 28.
We investigated how the microscopic quality of endotracheal aspirates (ETA) impacts the performance of the Filmarray® pneumonia plus panel (FA-PP) in patients undergoing mechanical ventilation (IMV) with suspicion of lower respiratory tract bacterial infection (LRTBI).
The quality of ETA was categorized according to the number of leukocytes and buccal squamous epithelial (BSE)/field (100x magnification). G5 (< 10 BSE cells and > 25 leukocytes/field) and G4 (10-25 BSE cells and > 25 leukocytes/field) ETA were tested in parallel by the FA-PP and conventional semiquantitative culture.
In total, 153 ETA were graded as G5 (from 115 patients) and 56 as G4 (from 48 patients). Focusing on "conventional" bacterial species, a trend towards more positive results (P = 0.16), and co-detections (P = 0.18) was returned by G5 ETA. Although more targets were detected on G5 ETA (P = 0.005), the spectra of bacteria detected was comparable across G5 and G4 specimens. A trend towards higher bacterial burdens as quantitated by the FA-PP, and irrespective of the target, was observed in G5 (median, 10 genome copies/ml) vs. G4 ETA (median, 10 genome copies/ml). The degree of full agreement between FA-PP and culture was higher for G5 ETA (Kappa value, 0.54; 95% CI, 0.43-0.66) than for G4 ETA (Kappa value, 0.31; 95% CI, 0.11-0.49). For all bacterial targets detected, genome copy/ml numbers exceeded colony forming units (CFU)/ml counts in 1-2 log, irrespective of ETA grading. The degree of correlation between genome copies/ml and CFU/ml was slightly better for G5 ETA (Rho = 0.65; P = 0.001) than for G4 ETA (Rho = 0.54; P = 0.11).
FA-PP testing of G5 ETA may provide more comprehensive and clinically useful information compared with G4 specimens in patients undergoing IMV with suspected LRTBI and receiving antimicrobial therapy. Yet G4 ETA may still provide useful microbiological information.
我们研究了气管内吸出物（ETA）的微观质量如何影响疑似下呼吸道细菌感染（LRTBI）的机械通气（IMV）患者中Filmarray®肺炎加检测板（FA-PP）的性能。
根据白细胞数量和颊鳞状上皮（BSE）/视野（100倍放大）对ETA质量进行分类。通过FA-PP和传统半定量培养对G5（<10个BSE细胞且>25个白细胞/视野）和G4（10-25个BSE细胞且>25个白细胞/视野）的ETA进行平行检测。
总共153份ETA被评为G5（来自115名患者），56份被评为G4（来自48名患者）。聚焦于“传统”细菌种类，G5的ETA有更阳性结果（P = 0.16）和共同检测结果（P = 0.18）的趋势。尽管在G5的ETA上检测到更多靶点（P = 0.005），但G5和G4标本中检测到的细菌谱相当。在G5（中位数，10个基因组拷贝/ml）与G4的ETA（中位数，10个基因组拷贝/ml）中，观察到FA-PP定量的细菌载量有升高趋势，且与靶点无关。G5的ETA中FA-PP与培养之间的完全一致性程度（Kappa值，0.54；95%CI，0.43-0.66）高于G4的ETA（Kappa值，0.31；95%CI，0.11-0.49）。对于所有检测到的细菌靶点，无论ETA分级如何，基因组拷贝/ml数比菌落形成单位（CFU）/ml计数超出1-2个对数。G5的ETA中基因组拷贝/ml与CFU/ml之间的相关性程度（Rho = 0.65；P = 0.001）略优于G4的ETA（Rho = 0.54；P = 0.11）。
对于疑似LRTBI并接受抗菌治疗的IMV患者，与G4标本相比，G5的ETA进行FA-PP检测可能提供更全面且临床有用的信息。然而，G4的ETA仍可能提供有用的微生物学信息。
