Diagnostic Performance of Multiplex Nucleic Acid Testing of Bronchoalveolar Lavage and Bronchial Wash Specimens for Respiratory Viral Pathogens

Abstract

There is limited knowledge on the yield of performing multiplex nucleic acid testing (NAT) on multiple lower respiratory tract specimens from a single patient with a single instance of infection. We evaluated the performance characteristics of multiplex NAT assays performed concurrently on bronchoalveolar lavage (BAL) and bronchial wash (BW) specimens to detect respiratory pathogens. A retrospective study of admitted patients from March 2013 through December 2016 was performed. Individual performance characteristics of BAL and BW specimens were compared to positive results from either set of specimens. Only contemporaneous BAL and BW specimens (received by the laboratory within 4 h of each other) were included. The final cohort included 170 patients, with 184 contemporaneous BAL and BW specimens submitted for multiplex NAT (median age, 58 years; 62% male). Of the patients with positive NAT results, 38 of 40 BW specimens tested positive (overall percent agreement with combined testing, 98.9%; 95% confidence interval [CI], 95.5 to 98.9%), and 34 of 40 BAL specimens tested positive (overall percent agreement with combined testing, 96.7%; 95% CI, 93.0 to 96.7%). Assays performed on BW specimens identified 4 additional specimens and had a higher positive percent agreement (95.0%) with combined testing results compared to those performed on BAL specimens (85.0%). There was exact concordance in 174 specimens (94.6%; negative and positive for respiratory pathogens, 144 and 34 specimens, respectively). We observed high concordance (95%) between multiplex NAT results from contemporaneous BAL and BW specimens. Performance characteristics of BW specimen testing were equivalent to those of BAL specimen testing. The benefit of performing additional testing should be carefully considered against the potential complications and health care costs.

Development and evaluation of a multiplex quantitative polymerase chain reaction assay for detecting bacteria associated with lower respiratory tract infection

“…The turnaround is typically on the scale of just a few hours ( Gadsby et al, 2015 ). Although commercially available PCR technology currently enables a respiratory specimen to be rapidly screened for a wide range of viral ( Munigala et al, 2018 ;Mustafa Hellou et al, 2021 ) and atypical bacterial pathogens ( McGovern et al, 2021 ;Oosterheert et al, 2005 ;Shengchen et al, 2019 ), most regions of China continue to rely on conventional microbiological techniques (such as Gram stain, culture, and urine antigen detection) to identify bacteria.…”

Bronchoalveolar lavage under ultrasound monitoring of lungs for the treatment of neonatal atelectasis and lung consolidation

“…During lavage treatment, transcutaneous oxygen saturation (SpO 2 ) of the child should be >90% (29,30). The analysis of the effects of BAL (29)(30)(31)(32)(33)(34) has revealed the following: i) During the lavage process, the uncomfortable stress response of the child stimulates the body through the hypothalamic-pituitary-adrenal axis to produce glucocorticoids, which exert anti-inflammatory effects, conducive to alveolar recruitment; ii) lavage can reduce inflammation and cytokine levels, and can eliminate certain inflammation and cytotoxic factors, thereby reducing their harm to the body; iii) it can wash out inflammatory exudate, edema fluid, necrotic tissue, etc., which is conducive to alveolar recruitment; iv) lavage fluid from the lavage can be used for smears, stains, and pathogenic examinations to provide a basis for a clear diagnosis and treatment.…”

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study

“…In such cases, respiratory physicians may therefore be asked to help in the diagnostic process by sampling the lower airways. Indeed, lower respiratory tract (LRT) sampling through bronchial endoscopy with either bronchoalveolar lavage (BAL) or bronchial washing (BW or mini BAL) has proved useful in the etiologic definition of pneumonia, even in the case of viral pneumonia [ 12 , 13 ]. For the SARS-CoV-2 infection, a PCR assay performed on a BAL has shown very high sensitivity [ 6 ].…”