Abstract
The diagnosis of LRTI is challenging.
Methods: This prospective, controlled study included 550 immunocompromised patients undergoing diagnostic BAL for suspicion of LRTI. Results of Curetis Unyvero P55, a test detecting genes of 21 microorganisms and antibiotic resistance in 4h, were compared to results of conventional microbiology and clinical judgment.
Results: 262 cases have been analyzed so far. Age was 57.9±15.1y, 59.2% male. Cough (55.7%), dyspnea (31.3%), phlegm (23.7%), fever (22.5%) and decrease in FEV1 (17.2%) were reported by SCT/hematological malignancies (40.8%) and solid organ Tx (18.7%). Median WBC was 6.8G/l and CRP 7.4mg/l. Chest-CT scans depicted abnormalities in 96.2%. 35.9% were on AB at bronchoscopy. Mean BAL neutrophils were 30.2% (±31.7). Non-candida fungi were detected in 9.5%, viruses by multiplex PCR in 38.5%. Resistance genes were evidenced in 89 cases. The diagnostic performance of the Unyvero is depicted in the Table.
Conclusion: The Unyvero P55 detects more potentially pathogenic bacteria than conventional methods in the bronchoalveolar lavage of immunocompromised patients. Whether patients, in whom these pathogens (particularly gram negative non-fermenters) were evidenced, benefit from antibiotic therapy is unclear. The sensitivity for gram positive bacteria must be improved. Studies are necessary to evaluate the impact of this method in clinical decision making, outcomes and costs.
- Copyright ©ERS 2015
