Sadaka Ahmed, Said Reda, Ashmawy Heba, Okasha Hadir, Gharraf Heba
Department of Chest Diseases, Alexandria University Faculty of Medicine, Alexandria (Egypt), El- Khartoum Square, Alexandria, 21526, Egypt.
Department of Medical Microbiology and Immunology, Alexandria University Faculty of Medicine, Alexandria, Egypt.
Respir Res. 2025 Apr 18;26(1):154. doi: 10.1186/s12931-025-03208-7.
Pleural infection is a commonly encountered respiratory disease but in > 40% the underlying microbiologic etiology is unknown. This feasibility study aims to investigate whether pleural fluid agitation prior to sample aspiration is safe and can improve the diagnostic yield of microbiologic analysis.
Thirty adult patients with pleural infection, based on clinical, imaging and biochemical evidence, were included in this feasibility study. Ultrasound guided thoracentesis was performed with an initial standard aspiration sampling technique, followed by pleural fluid agitation into the pleural cavity for 3-5 cycles before collecting the agitated fluid. Coded samples were sent for biochemical and microbiologic analysis with culture in aerobic and anaerobic media.
No complications were encountered with the pleural fluid agitation technique. Overall, 14 (46.6%) of patients had a positive pleural fluid culture. No yield discordance was noted between the standard and the agitated pleural fluid sampling techniques except for 1 extra agitated sample growing klebsiella pneumoniae and another agitated sample with mixed infection showing an additional anaerobic bacterial growth. Four (30.8%) of the 13 concordantly positive samples showed heavier bacterial growth in the agitated samples using semi-quantitative culture scoring.
Pleural fluid agitation was safe but didn't significantly add to the microbiologic yield in pleural infection. However, higher bacterial growth in almost one third of positive samples suggests a potential effect for further investigation in a larger study. Despite being safe, pleural fluid agitation resulted in no significant improvement in the microbiologic yield among pleural infection. However, agitated samples grew more bacteria in almost a third of the positive samples suggesting a signal for further investigation in a larger study.
Clinicaltrials.gov - NCT05702580, 23/12/2022.
胸腔感染是一种常见的呼吸系统疾病，但超过40%的病例其潜在的微生物病因不明。本可行性研究旨在调查在抽取样本前对胸腔积液进行搅动是否安全，以及能否提高微生物分析的诊断率。
基于临床、影像学和生化证据，30例成年胸腔感染患者纳入本可行性研究。采用初始标准抽吸采样技术进行超声引导下胸腔穿刺，随后将胸腔积液在胸腔内搅动3 - 5个循环，然后收集搅动后的液体。编码样本送去进行生化和微生物分析，并在需氧和厌氧培养基中培养。
胸腔积液搅动技术未出现并发症。总体而言，14例（46.6%）患者胸腔积液培养呈阳性。除1份搅动样本培养出肺炎克雷伯菌，另1份搅动样本混合感染显示有额外的厌氧菌生长外，标准和搅动胸腔积液采样技术之间未发现诊断率不一致的情况。在13份一致呈阳性的样本中，4份（30.8%）使用半定量培养评分显示搅动样本中的细菌生长更旺盛。
胸腔积液搅动是安全的，但并未显著提高胸腔感染的微生物诊断率。然而，近三分之一的阳性样本中细菌生长更旺盛，这表明在更大规模的研究中进一步调查可能会有潜在效果。尽管安全，但胸腔积液搅动并未使胸腔感染的微生物诊断率有显著提高。然而，近三分之一的阳性样本中搅动样本生长的细菌更多，这表明在更大规模的研究中进一步调查有一定迹象可循。
Clinicaltrials.gov - NCT05702580，2022年12月23日。
Zotero 插件