Lee Young Ho, Kang Min Seo, Yang Jinyoung, Kim Si-Ho, Ko Jae-Hoon, Cho Sun Young, Kim Tae Yeul, Huh Hee Jae, Lee Nam Yong, Kang Cheol-In, Chung Doo Ryeon, Peck Kyong Ran, Huh Kyungmin
Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Microbiol Spectr. 2025 Aug 5;13(8):e0035225. doi: 10.1128/spectrum.00352-25. Epub 2025 Jun 12.
Microbiological diagnosis of pleural infection is often hindered by the low sensitivity of conventional culture. The automated blood culture system (ABCS) has been shown to improve diagnostic sensitivity for the culture of non-blood specimens. This study examined the additional diagnostic benefit of ABCS against conventional bacterial culture in patients who underwent thoracentesis or percutaneous drainage. Non-duplicate patients whose pleural fluid samples were tested using both conventional culture and ABCS (BACT/ALERT 3D and VIRTUO, bioMerieux) from 2001 through 2021 were included. Cases were excluded if only contaminants such as coagulase-negative staphylococci, species, and species were identified. Data on culture results, demographics, and laboratory tests were collected. Of the 9,020 patients, 632 patients had positive results in ABCS after excluding those considered contaminants ( = 180) or those positive only in conventional culture ( = 5). Conventional culture was positive in 302 (47.8%) patients, whereas 330 (52.2%) patients had isolates only from ABCS. Patients with positive results from ABCS alone had lower pleural fluid lactate dehydrogenase and serum C-reactive protein (CRP) and higher pleural fluid glucose and protein. Among organisms isolated from ABCS alone, viridans group streptococci and spp. were the most common organisms identified. Higher pleural fluid glucose and blood white blood cells and lower CRP were significant factors associated with exclusive ABCS positivity. More than half of the patients whose pleural fluid cultures were positive using ABCS had a negative result on conventional culture. Our results suggest that ABCS might enhance the microbiologic diagnosis of pleural infection.IMPORTANCEThis study demonstrated that an automated blood culture system (ABCS) has superior sensitivity in pleural infections compared with conventional culture. By comparing both methods in over 9,000 patients, researchers found that ABCS detected bacteria in approximately twice as many cases as conventional culture, especially in patients with a high probability of pleural infection. The findings suggest that ABCS can be a valuable tool in improving the accuracy of diagnosing pleural infections, which could lead to better treatment decisions and patient outcomes.
胸膜感染的微生物学诊断常常受到传统培养方法低敏感性的阻碍。自动血培养系统（ABCS）已被证明可提高非血液标本培养的诊断敏感性。本研究探讨了在接受胸腔穿刺术或经皮引流的患者中，ABCS相对于传统细菌培养的额外诊断益处。纳入了2001年至2021年期间使用传统培养和ABCS（BACT/ALERT 3D和VIRTUO，生物梅里埃公司）对胸腔积液样本进行检测的非重复患者。如果仅鉴定出凝固酶阴性葡萄球菌、某些菌种等污染物，则排除该病例。收集了培养结果、人口统计学和实验室检查数据。在9020例患者中，排除被视为污染物的患者（n = 180）或仅传统培养呈阳性的患者（n = 5）后，有632例患者ABCS结果呈阳性。302例（47.8%）患者传统培养呈阳性，而330例（52.2%）患者仅ABCS分离出病原体。仅ABCS结果呈阳性的患者胸腔积液乳酸脱氢酶和血清C反应蛋白（CRP）较低，胸腔积液葡萄糖和蛋白较高。仅从ABCS分离出的病原体中，草绿色链球菌和某些菌种是最常见的鉴定出的病原体。较高的胸腔积液葡萄糖和血白细胞以及较低的CRP是与仅ABCS阳性相关的显著因素。使用ABCS胸腔积液培养呈阳性的患者中，超过一半的患者传统培养结果为阴性。我们的结果表明，ABCS可能会增强胸膜感染的微生物学诊断。重要性本研究表明，与传统培养相比，自动血培养系统（ABCS）在胸膜感染中具有更高的敏感性。通过对9000多名患者比较这两种方法，研究人员发现ABCS检测到细菌的病例数约为传统培养的两倍，尤其是在胸膜感染可能性高的患者中。这些发现表明，ABCS可以成为提高胸膜感染诊断准确性的有价值工具，这可能会带来更好的治疗决策和患者预后。
