医学
肺炎
一致性
微生物学
多重聚合酶链反应
医学微生物学
临床微生物学
重症监护室
社区获得性肺炎
呼吸道感染
抗生素
内科学
呼吸机相关性肺炎
病毒学
生物
聚合酶链反应
呼吸系统
基因
生物化学
作者
Virve I. Enne,Alp Aydin,Rossella Baldan,Dewi R Owen,Hollian Richardson,Federico Ricciardi,Charlotte Russell,Brenda O. Nomamiukor-Ikeji,Ann-Marie Swart,Juliet High,Antony Colles,Julie Barber,Vanya Gant,David M. Livermore,Justin O’Grady
出处
期刊:Thorax
[BMJ]
日期:2022-01-13
卷期号:77 (12): 1220-1228
被引量:50
标识
DOI:10.1136/thoraxjnl-2021-216990
摘要
Background Culture-based microbiological investigation of hospital-acquired or ventilator-associated pneumonia (HAP or VAP) is insensitive, with aetiological agents often unidentified. This can lead to excess antimicrobial treatment of patients with susceptible pathogens, while those with resistant bacteria are treated inadequately for prolonged periods. Using PCR to seek pathogens and their resistance genes directly from clinical samples may improve therapy and stewardship. Methods Surplus routine lower respiratory tract samples were collected from intensive care unit patients about to receive new or changed antibiotics for hospital-onset lower respiratory tract infections at 15 UK hospitals. Testing was performed using the BioFire FilmArray Pneumonia Panel (bioMérieux) and Unyvero Pneumonia Panel (Curetis). Concordance analysis compared machine and routine microbiology results, while Bayesian latent class (BLC) analysis estimated the sensitivity and specificity of each test, incorporating information from both PCR panels and routine microbiology. Findings In 652 eligible samples; PCR identified pathogens in considerably more samples compared with routine microbiology: 60.4% and 74.2% for Unyvero and FilmArray respectively vs 44.2% by routine microbiology. PCR tests also detected more pathogens per sample than routine microbiology. For common HAP/VAP pathogens, FilmArray had sensitivity of 91.7%–100.0% and specificity of 87.5%–99.5%; Unyvero had sensitivity of 50.0%–100.0%%, and specificity of 89.4%–99.0%. BLC analysis indicated that, compared with PCR, routine microbiology had low sensitivity, ranging from 27.0% to 69.4%. Interpretation Conventional and BLC analysis demonstrated that both platforms performed similarly and were considerably more sensitive than routine microbiology, detecting potential pathogens in patient samples reported as culture negative. The increased sensitivity of detection realised by PCR offers potential for improved antimicrobial prescribing.
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