Abstract
BackgroundCulturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood.ObjectiveThe aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method.MethodsWe investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared.ResultsPathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125).ConclusionCompared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.
Highlights
Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia
Compared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and adds important information to guide anti-infective therapy
Pathogen detection was more frequent by SF (83%) than by culture (31%, p < 0.001; Table 2)
Summary
Culturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. A multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood. Severe bacterial and fungal infections in critically ill patients require immediate anti-infective treatment to reduce mortality [1, 2]. Bronchoalveolar lavage (BAL) is frequently performed in patients with severe pneumonia for microbiological workup. Antibiotic treatment is started empirically, as the underlying infectious pathogen is unknown. It is crucial to modify/deescalate antibiotic treatment according to microbiological results to optimize efficacy and to reduce the side effects. For pneumonia and bloodstream infections, cultivation of underlying. As bronchoscopy and BAL in children with pneumonia are associated with an elevated risk for complications [8], examination of BAL fluid samples requires special attention
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