Computed tomography imaging-guided lung biopsy and tissue culture applied in the diagnosis of pulmonary infectious diseases

Pulmonary infectious diseases have high incidence and mortality, and accurate etiological diagnosis is crucial for optimizing treatment and reducing antibiotic resistance. Conventional methods like sputum and blood culture have limitations such as low positivity, easy contamination, and insufficient sensitivity to specific pathogens, leading to limited efficacy of empirical therapy. This study aimed to evaluate the diagnostic efficacy of CT-guided lung biopsy combined with tissue culture, and compare pathogen detection rates and diagnostic consistency among different strategies. A retrospective analysis was performed on 313 suspected patients divided into six groups. Microbial culture positivity, drug resistance, histopathological, and molecular indicators were detected, with consistency assessed by Kappa test (P < 0.05 for significance). Propensity score matching was used to correct confounding factors. Results showed biopsy-based groups had higher culture positivity than conventional groups, and combined detection further improved positivity and yielded the most comprehensive pathogen spectrum. Optimized biopsy with molecular testing enhanced specific pathogen detection. The 42.9% macrolide resistance rate of Mycoplasma pneumoniae was associated with prior medication and regional epidemiology. Combined groups showed excellent diagnostic consistency (Kappa = 0.78-0.82). Tissue-to-serum inflammatory protein ratio (stable at 0.5) correlated with clinical outcomes, serving as an auxiliary evaluation indicator. Biopsy-related complications were mild to moderate (28.5% total incidence). CT-guided lung biopsy is superior to conventional detection; their combination and optimization improve diagnostic performance, supporting precision medicine for pulmonary infections.