Polymerase‐chain reaction/electrospray ionization‐mass spectrometry for the detection of bacteria and fungi in bronchoalveolar lavage fluids: a prospective observational study

Abstract PLEX‐ID uses polymerase chain reaction‐electrospray ionization/mass spectrometry for rapid identification of infectious agents in clinical samples. We evaluated its concordance with our centre's standard methods (SM) for bacterial and fungal detection in bronchoalveolar lavage (BAL) fluid in a prospective observational cohort study. The primary outcome was concordance (%) between SM and PLEX‐ID. Secondary outcomes included concordance when excluding commensal oral flora, detection of resistance genes, and PLEX‐ID's potential impact on clinical management, as determined by two independent reviewers. Included were 101 specimens from 94 patients. BALs were performed primarily for suspected pneumonia (76/101, 75%) and lung transplant work‐ups (12/101, 12%). Most specimens yielded at least one organism by either method (92/101, 91%). Among all microorganisms detected (n = 218), 83% and 17% were bacterial and fungal, respectively. Overall concordance between SM and PLEX‐ID was 45% (45/101). Concordance increased to 66% (67/101) when discordance for commensal flora was excluded. PLEX‐ID failed to detect 21% of all 183 SM‐identified organisms, while SM did not identify 28% of the 191 PLEX‐ID‐identified organisms (p <0.001). There was low concordance for mecA detection. Two infectious‐disease specialists' analyses concluded that in most of the 31 discordant, non‐commensal cases, PLEX‐ID results would have had little or no impact on patient mana...
Source: Clinical Microbiology and Infection - Category: Microbiology Authors: Tags: Original Article Source Type: research