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

Sircar, Mrinal; Ranjan, Prashant; Gupta, Rajesh K.; Jha, Onkar; Gupta, Amit; Kaur, Ravneet; Chavhan, Neela; Singh, Mukta; Singh, Sujeet Kumar

doi:10.1016/j.jcrc.2015.10.012

Cited by 19 publications

(16 citation statements)

References 31 publications

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“…Experience with BAL PCR in LTx recipients is limited to P. jirovecii and respiratory viruses, the foremost being cytomegalovirus . Unlike the clinical scenario studied herein, a multitude of studies assessing multiplex PCR in patients with suspected ventilator‐associated pneumonia argue for its usefulness in the ICU setting . None of the patients in this study, however, was transferred to the ICU, where a time difference of 2 hours might bear greater significance.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

Drick

Seeliger

Greer

et al. 2017

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 95%

“…9,10 Unlike the clinical scenario studied herein, a multitude of studies assessing multiplex PCR in patients with suspected ventilator-associated pneumonia argue for its usefulness in the ICU setting. [11][12][13][14]…”

Section: Time To Final Diagnosismentioning

confidence: 99%

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

Drick

Seeliger

Greer

et al. 2017

Transplant Infectious Dis

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“…SES technology is being routinely used in other hospitals in India and has been shown to increase the diagnostic yield as well as reduce the time to antibiotic therapy modification including deescalation. [44] The technology has also been used to study the etiology of community-acquired pneumonia among children in India. [45]…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study

Ramalingam¹,

Chakraborty²

2016

Ann Indian Acad Neurol

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Background:Central nervous system (CNS) infections present a grave health care challenge due to high morbidity and mortality. Clinical findings and conventional laboratory assessments are not sufficiently distinct for specific etiologic diagnosis. Identification of pathogens is a key to appropriate therapy.Aim:In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections.Materials and Methods:This retrospective analysis included inpatients in our tertiary level neurointensive care unit (NICU) and ward from February 2010 to December 2013. Cerebrospinal fluid (CSF) samples of 70 patients, clinically suspected of having CNS infections, were subjected to routine laboratory tests, culture, imaging, and SES. We analyzed the efficacy of SES in the diagnosis of CNS infections and its utility in therapeutic decision-making.Results:SES had a clinical sensitivity of 57.4% and clinical specificity of 95.6%. Streptococcus pneumoniae and Pseudomonas aeruginosa were the top two bacterial pathogens, whereas Herpes simplex virus (HSV) was the most common viral pathogen. Polymicrobial infections were detected in 32.14% of SES-positive cases. SES elicited a change in the management in 30% of the patients from initial empiric therapy. At discharge, 51 patients recovered fully while 11 patients had partial recovery. Three-month follow-up showed only six patients to have neurological deficits.Conclusion:In a tertiary care center, etiological microbial diagnosis is central to appropriate therapy and outcomes. Sensitive and accurate multiplex molecular diagnostics play a critical role in not only identifying the causative pathogen but also in helping clinicians to institute appropriate therapy, reduce overuse of antimicrobials, and ensure superior clinical outcomes.

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“…The article by Sircar et al [1] on the use of multiplex polymerase chain reaction (M-PCR) for therapeutic decisions in severe pneumonia in intensive care unit is very interesting. The article suffers from the following shortcomings.…”

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confidence: 99%

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

Kumar

2016

Journal of Critical Care

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Comments on "Impact of bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit" Dear Editor,The article by Sircar et al [1] on the use of multiplex polymerase chain reaction (M-PCR) for therapeutic decisions in severe pneumonia in intensive care unit is very interesting. The article suffers from the following shortcomings.1) Comparing 2 different M-PCR with standard culture of a nonsterile sample like bronchoalveolar lavage is like comparing apples and oranges. The M-PCR is very sensitive, picks up many organisms including colonizers, does not give the colony-forming unit which is critical to determine if the isolate is significant [2], picks up viruses and anaerobes which are usually not investigated in conventional cultures, and last but not the least, does not pick up pathogens like Geotrichum, Mucor, Burkholderia cepacia, Serratia spp, and Stenotrophomonas maltophilia mentioned in the study. Therefore, the study design itself is faulty. The authors need to include organisms that are picked up by both the tests to have a head-tohead comparison. 2) Enterococcus and Candida rarely cause pneumonia in most patients.They are considered colonizers unless concomitantly isolated from blood or histopathologically proven [2,3].3) The authors have never attempted to define conventional cultures of bronchoalveolar lavage. Does it include anaerobic, viral, fungal, and Mycobacterium tuberculosis cultures. They could have briefly described how the isolates were identified and susceptibility testing was done. 4) As expected 70% (41/58) of the samples showed more than 3 organisms in M-PCR. How were the authors able to decide which were pathogens and which were colonizers. In the absence of quantitative/semiquantitative methods, it is very difficult to differentiate between both. The M-PCR will always lead to overdiagnosis and overkill. 5) How was reporting time for conventional cultures determined? Presumptive identification of most of the pathogens like Escherichia coli, Klebsiella spp, Acinetobacter spp, Staphylococcus aureus, B cepacia, Pseudomonas spp, Enterococcus spp, and so on, can be made in 18 to 24 hours using automated identification systems [4][5][6]. Sensitivity, however, would take another 12 to 18 hours, which was not the objective of the study. Therefore, reporting time for cultures should be till identification and not till generation of Journal of Critical Care 33 (2016) 274 0883-9441/

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

Cited by 19 publications

References 31 publications

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

DNA‐based testing in lung transplant recipients with suspected non‐viral lower respiratory tract infection: A prospective observational study

Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study

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

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