Clinical application of multiplex PCR in adults with parapneumonic pleural effusion

Complicated parapneumonic pleural effusion is associated with high mortality, prolonged antibiotics use and low culture positivity. BioFire® FilmArray® is a multiplex PCR system for rapid identification of pathogens on bronchoalveolar lavage, sputum or blood. <bold>Methods:</bold> A prospective cohort study on the feasibility of pathogen identification by FilmArray in adult patients with suspected parapneumonic pleural effusion. Pleural fluid was sent for both conventional microbiological identification culture and FilmArray (BCID2 +/- Pneumonia Plus panel). <bold>Results:</bold> 13 patients (10 males, median age, 65 years) were recruited. Underlying medical conditions were present in 6 patients (1 with dental problem, 1 with diabetes mellitus and 4 with malignancy). All pleural fluid had increased total white cell count (median 7456 cells/ml) with median polymorph of 79%. 8 samples had positive culture and/or FilmArray results (Table). In 5 samples with positive cultures, the same organisms were detected by FilmArray panels (A to E). One FilmArray positive sample (F) had no growth in culture. <bold>Conclusion:</bold> FilmArray BCID2 and Pneumonia Plus panel are useful adjunctive diagnostic tools in rapid identification of pathogens in parapneumonic pleural effusion. <bold>Table.</bold> Summary of 8 samples with positive results <table-wrap><object-id>erj;64/suppl_68/PA1504/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td><bold>Sample</bold></td><td><bold>Culture</bold></td><td><bold>BCID2 panel</bold></td><td><bold>Pneumonia Plus panel</bold></td></tr><tr><td>A</td><td><italic>S. aureus</italic></td><td>-</td><td><italic>S. aureus</italic></td></tr><tr><td>B</td><td> <italic>Klebsiella pneumoniae</italic> <italic>Enterococcus gallinarum</italic> </td><td><italic>Klebsiella pneumoniae</italic> group</td><td>-</td></tr><tr><td>C</td><td><italic>S. aureus</italic></td><td><italic>S. aureus</italic></td><td>-</td></tr><tr><td>D</td><td><italic>S. aureus</italic></td><td>-</td><td><italic>S. aureus</italic></td></tr><tr><td>E</td><td><italic>Parvimonas micra</italic> <italic>Streptococcus anginosus</italic></td><td><italic>Streptococcus</italic> spp.</td><td><italic>-</italic></td></tr><tr><td>F</td><td>No growth</td><td><italic>P. aeruginosa</italic></td><td><italic>P. aeruginosa</italic> <italic>Acinetobacter calcoaceticus-baumannii complex</italic></td></tr><tr><td>G</td><td><italic>M. tuberculosis</italic></td><td>-</td><td>-</td></tr><tr><td>H</td><td><italic>M. tuberculosis</italic></td><td>-</td><td>-</td></tr></tbody></table></table-wrap> -, Not performed