Impact of bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit

Autor: Mrinal Sircar, Prashant Ranjan, Mukta Singh, Amit Gupta, Onkar Kumar Jha, Neela Chavhan, Sujeet Kumar Singh, Rajesh Gupta, Ravneet Kaur
Rok vydání: 2015
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
medicine.drug_class
Antibiotics
Critical Care and Intensive Care Medicine
Bronchoalveolar Lavage
Article
law.invention
Sepsis
03 medical and health sciences
0302 clinical medicine
law
Internal medicine
Culture Techniques
Multiplex polymerase chain reaction
medicine
Humans
Hospital Mortality
Aged
Retrospective Studies
medicine.diagnostic_test
Bacteria
business.industry
Septic shock
Fungi
030208 emergency & critical care medicine
Retrospective cohort study
Pneumonia
Middle Aged
medicine.disease
Intensive care unit
Shock
Septic
Surgery
Anti-Bacterial Agents
Intensive Care Units
Bronchoalveolar lavage
Treatment Outcome
030228 respiratory system
Case-Control Studies
Viruses
Female
business
Bronchoalveolar Lavage Fluid
Multiplex Polymerase Chain Reaction
Zdroj: Journal of Critical Care
ISSN: 1557-8615
Popis: The purpose of the study is to evaluate the impact of adding bronchoalveolar lavage multiplex polymerase chain reaction (M-PCR) to conventional cultures (CC) on microbiological yield and therapeutic decisions in adult intensive care unit patients with pneumonia and severe sepsis or septic shock.In this retrospective case-control study, bronchoalveolar lavage cultures were taken for control (58 patients, 58 admissions) and study arms (57 patients, 58 admissions). Bronchoalveolar lavage M-PCR was sent simultaneously for the latter.A total of 267 microorganisms were identified (M-PCR alone, 211; CC alone, 15; both, 41) in the study arm vs 64 in controls. Concordance between M-PCR and culture was complete in 32 (55.17%), partial in 4 (6.9%), and discordant in 22 (37.93%) including 17 with positive M-PCR but negative CC. Time to antibiotic therapy modification was significantly less (P.001) in M-PCR group compared to controls (32.40 ± 14.41 vs 41.74 ± 45.61 hours). There was no significant difference in index episode resolution (48.3% vs 50%; P = 1), intensive care unit mortality (57.4% vs 51.2%; P = .67), and hospital mortality (59.6% vs 61.5%; P = 1) in study and control arms, respectively, despite more septic shock patients in the study arm (89.7% vs 75.9%; P = .05).Bronchoalveolar lavage M-PCR with culture leads to higher microbiological yield and earlier modification of antibiotics compared to conventional culture.
Databáze: OpenAIRE
Externí odkaz: