Abstract
Objective: To evaluate BAL multiplex PCR with DNA macrochip (Syndrome Evaluation System (SES), Xcyton Diagnostics Pvt. Ltd., India) in etiological diagnosis of severe pneumonia and its impact on outcomes.
Method: Bronchoscopic BAL in 25 (27 episodes) adult patients with severe pneumonia was tested by conventional culture methods (CC) and SES. Empirical antibiotics were modified based on the results. Index infection, ICU, hospital and 30 day outcomes were compared with matched controls.
Results: BAL was obtained from 25 (27 episodes) study patients [mean±SD age 61.3±18.3 yrs] and 27 control patients [age 60.9±18.3 yrs]. There was no significant difference in the age (p=0.94), APACHE IV score (74.6±27.3 vs. 76.6±29; p=0.8) and predicted mortality (29±22.3 vs. 26.9±21.2; p=0.72), ICU length of stay (LOS) (p=0.49) and hospital LOS (p=0.73) between the groups. Mechanical ventilation was required for 26 episodes in study and 25 in controls.
In the study arm all BAL were positive by SES, 9 were sterile by CC and 18 were positive by both methods. SES missed 4 organisms picked up by CC. In controls 7/27 BAL were sterile by CC.
In the study arm there was significantly less time to antibiotic modification (p<0.001) based on SES (31.18±8.44 hrs) as compared to CC (including Gram stain and colony morphology) (52.81±17.71 hrs). Observed 30 days mortality was 15/25 (study) and 13/27 (control). Index infection cure rates (p=1) and ICU (p=0.27), hospital (p=0.49) and 30 day (p=0.57) mortality were not significantly different in the two groups.
Conclusions: Multiplex PCR (SES) helps in early modification of empirical therapy but shows no impact on severe pneumonia outcome.
- © 2011 ERS
