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Multiplex bacterial PCR in the bronchoalveolar lavage fluid of non-intubated patients with suspected pulmonary infection: a quasi-experimental study

Anna Salina, Desiree M. Schumann, Léo Franchetti, Kathleen Jahn, Kurosch Purkabiri, Raphael Müller, Werner Strobel, Nina Khanna, Michael Tamm, Daiana Stolz
ERJ Open Research 2022 8: 00595-2021; DOI: 10.1183/23120541.00595-2021
Anna Salina
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Desiree M. Schumann
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Léo Franchetti
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Kathleen Jahn
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Kurosch Purkabiri
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Raphael Müller
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Werner Strobel
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Nina Khanna
2Clinic of Infectiology and Hospital Hygiene, University Hospital Basel, Basel, Switzerland
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Michael Tamm
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
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Daiana Stolz
1Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
3Faculty of Medicine, Clinic of Respiratory Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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  • For correspondence: daiana.stolz@usb.ch
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  • FIGURE 1
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    FIGURE 1

    Flow chart depicting study design including 605 cases with suspected pulmonary infection. BAL: bronchoalveolar lavage.

Tables

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  • TABLE 1

    In-panel microorganisms and resistance genes detected by the Curetis Unyvero - P50 assay

    Gram-positive bacteriaGram-negative bacteriaFungiResistance genesResistance against
    Staphylococcus aureusAcinetobacter baumanniiPneumocystis jiroveciictx-M3rd generation cephalosporins
    Streptococcus mitis groupChlamydophila pneumoniaeermAMacrolides/lincosamides
    Escherichia coliermBMacrolides/lincosamides
    Enterobacter spp.ermCMacrolides/lincosamides
    Haemophilus influenzaeInt1MDR
    Klebsiella pneumoniaekpcCarbapenems
    Klebsiella oxytocamecAOxacillin
    Legionella pneumophilamsrAMacrolide
    Moraxella catarrhalismefAMacrolide
    Morganella morganiioxa-51Carbapenems
    Pseudomonas aeruginosashvPenicillin
    Proteus spp.sul1Sulfonamide
    Serratia marcescensdha3rd generation cephalosporins
    Stenotrophomonas maltophiliatem-shv3rd generation cephalosporins
    shvPenicillin
    tem1Penicillin
    gyrA832_PseuFluoroquinolones
    gyrA833_PseuFluoroquinolones
    gyrA872_PseuFluoroquinolones
    gyrA873_PseuFluoroquinolones
    gyrA83_EcoliFluoroquinolones
    gyrA87_EcoliFluoroquinolones
    parCPseuFluoroquinolones
    • MDR: multidrug resistant.

  • TABLE 2

    Demographics of patients undergoing bronchoalveolar lavage for suspicion of pulmonary infection

    Patient characteristicsn (%), mean±sdMultiplex PCRConventional culturep-value
    Age years62±15.560±15.960±14.60.82
    Female198/470 (42)140/322 (43)58/148 (39)0.42
    Weight kg68±17.9670±18.169±17.70.83
    Height cm169±9.4169±9.6169±9.00.82
    Setting0.78
     Ambulatory213/605 (35)147/417 (35)64/188 (34)
     Hospitalised392/605 (65)270/417 (65)124/188 (66)
    Smoking status0.79
     Current smokers126/605 (21)86/403 (21)40/183 (22)
     Former smokers237/605 (39)160/403 (40)77/183 (42)
     Pack-years, median (IQR)30 (15–50)30 (15–50)30 (18.75–50)0.78
    Respiratory symptoms before bronchoscopy:
     Cough316/399(79)215/370 (58)101/167 (60)0.64
     Sputum239/537(45)167/370 (45)72/167 (43)0.71
     Dyspnoea226/399(57)156/370 (42)70/167 (42)1.00
     Thoracic pain66/399(17)50/370 (14)16/167 (10)0.26
    Pathological findings on CT and/or radiograph284/348 (82)194/235 (83)90/113 (80)0.56
     Consolidation223 (79)154 (79)69 (77)0.47
     Pleural effusion101 (36)76 (39)25 (28)0.06
     Interstitial pattern63 (22)40 (21)23 (26)0.46
     Cavities13 (5)10 (5)3 (3)0.56
    Laboratory findings values before bronchoscopy
     C-reactive protein mg·L−120±8768±9351±700.27
     Procalcitonin ng mL−10.08±1.220.4±1.40.2±0.60.37
     White blood cells (×109)7.94±5.89.0±5.98.6±5.50.45
     Neutrophil leukocyte count (×109)5.28±4.66.5±4.96.1±3.70.95
     Haemoglobin g·L−1120±24118±24120±230.46
     Glucose mmol·L−15.9±2.56.5±2.27.0±3.00.18
     BUN mmol·L−16.3±5.447.8±5.67.8±5.20.46
     Creatinine μmol L−176±6394±6298±680.24
    Final diagnosis
     Bacterial infection18854/144 (37.5)45/188 (24)0.00
     Probably bacterial infection18321/116 (18)16/183 (9)
     No bacterial infection23432/160 (20)22/234 (9)

    IQR: interquartile range; CT: computed tomography; BUN: blood urea nitrogen.

    • TABLE 3

      The number of times the microorganisms present in the Curetis Unyvero P50 assay were detected by conventional methods and the multiplex PCR assay

      Conventional method +
      PCR +
      Conventional method –
      PCR +
      Conventional method +
      PCR –
      Acinetobacter baumannii250
      Chlamydophila pneumoniae010
      Escherichia coli535
      Haemophilus influenzae8204
      Klebsiella oxytoca110
      Klebsiella pneumoniae212
      Legionella pneumophila010
      Moraxella catarrhalis261
      Morganella morganii020
      Proteus spp.010
      Pseudomonas aeruginosa1352
      Serratia marcescens410
      Staphylococcus aureus1167
      Stenotrophomonas maltophilia631
      Streptococcus mitis/Streptococcus pneumoniae8167
      Total627229

    Supplementary Materials

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    • Supplementary Material

      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary material 00595-2021.SUPPLEMENT

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    Multiplex bacterial PCR in the bronchoalveolar lavage fluid of non-intubated patients with suspected pulmonary infection: a quasi-experimental study
    Anna Salina, Desiree M. Schumann, Léo Franchetti, Kathleen Jahn, Kurosch Purkabiri, Raphael Müller, Werner Strobel, Nina Khanna, Michael Tamm, Daiana Stolz
    ERJ Open Research Apr 2022, 8 (2) 00595-2021; DOI: 10.1183/23120541.00595-2021

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    Multiplex bacterial PCR in the bronchoalveolar lavage fluid of non-intubated patients with suspected pulmonary infection: a quasi-experimental study
    Anna Salina, Desiree M. Schumann, Léo Franchetti, Kathleen Jahn, Kurosch Purkabiri, Raphael Müller, Werner Strobel, Nina Khanna, Michael Tamm, Daiana Stolz
    ERJ Open Research Apr 2022, 8 (2) 00595-2021; DOI: 10.1183/23120541.00595-2021
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