Abstract
BackgroundThe identification of the pathogens in pleural effusion has mainly relied on conventional bacterial culture or single species polymerase chain reaction (PCR), both with relatively low sensitivity. We investigated the efficacy of a commercially available multiplex bacterial PCR assay developed for pneumonia to identify the pathogens involved in pleural infection, particularly empyema.MethodsA prospective, monocentric, observational study including 194 patients with pleural effusion. Patients were evaluated based on imaging, laboratory values, pleura ultrasound and results of thoracentesis including conventional microbiology studies during hospitalisation. Multiplex bacterial PCR (Curetis Unyvero p55) was performed in batch and had no influence on therapeutic decisions.ResultsOverall, there were 51/197 cases with transudate and 146/197 with exudate. In 42% (n = 90/214) there was a clinical suspicion of parapneumonic effusion and the final clinical diagnosis of empyema was made in 29% (n = 61/214) of all cases. The most common microorganisms identified in the cases diagnosed with empyema were anaerobes [31] followed by gram-positive cocci [10] and gram-negative rods [4]. The multiplex PCR assay identified more of the pathogens on the panel than the conventional methods (23.3% (7/30) vs. 6.7% (2/30), p = 0.008).ConclusionThe multiplex PCR-based assay had a higher sensitivity and specificity than conventional microbiology when only the pathogens on the pneumonia panel were taken into account. A dedicated pleural empyema multiplex PCR panel including anaerobes would be needed to cover most common pathogens involved in pleural infection.
Highlights
The identification of the pathogens in pleural effusion has mainly relied on conventional bacterial culture or single species polymerase chain reaction (PCR), both with relatively low sensitivity
The most common microorganisms identified by conventional methods and the multiplex PCR assay in the cases diagnosed with empyema were anaerobes (31/45) followed by gram-positive cocci (10/45) and gram-negative rods (4/45)
As found previously [29], we found no association between the multiplex PCR-based assay and prior administration of antibiotics or duration of antibiotic use before sampling in the cases diagnosed with empyema
Summary
The identification of the pathogens in pleural effusion has mainly relied on conventional bacterial culture or single species polymerase chain reaction (PCR), both with relatively low sensitivity. Multiplex PCR methods in different matrices (blood, sputum, Franchetti et al BMC Infectious Diseases (2020) 20:99 throat or nasopharyngeal swabs) have proven to be useful in diagnosing respiratory tract infections and decreasing the financial costs [8]. They have shown a better sensitivity [9, 10], especially in children [11, 12]. Some studies have shown limitations to the sensitivity of the PCR [13]
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