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A Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The
Ioannis Psallidas1, Nikolaos I Kanellakis1, Rahul Bhatnagar2
1Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
Background:
Pleural infection is a common complication of pneumonia associated with high mortality and poor clinical outcome. Treatment of pleural infection relies on the use of broad-spectrum antibiotics because reliable pathogen identification occurs infrequently. We performed a feasibility interventional clinical study assessing the safety and significance of ultrasound (US)-guided pleural biopsy culture to increase microbiological yield. In an exploratory investigation, the 16S ribosomal RNA technique was applied to assess its utility on increasing speed and accuracy vs standard microbiological diagnosis.
Methods:
Twenty patients with clinically established pleural infection were recruited. Participants underwent a detailed US scan and US-guided pleural biopsies before chest drain insertion, alongside standard clinical management. Pleural biopsies and routine clinical samples (pleural fluid and blood) were submitted for microbiological analysis.
Results:
US-guided pleural biopsies were safe with no adverse events. US-guided pleural biopsies increased microbiological yield by 25% in addition to pleural fluid and blood samples. The technique provided a substantially higher microbiological yield compared with pleural fluid and blood culture samples (45% compared with 20% and 10%, respectively). The 16S ribosomal RNA technique was successfully applied to pleural biopsy samples, demonstrating high sensitivity (93%) and specificity (89.5%).
Conclusions:
Our findings demonstrate the safety of US-guided pleural biopsies in patients with pleural infection and a substantial increase in microbiological diagnosis, suggesting potential niche of infection in this disease. Quantitative polymerase chain reaction primer assessment of pleural fluid and biopsy appears to have excellent sensitivity and specificity.
Insights
Ultrasound-guided pleural biopsy culture is a safe and effective method to improve pathogen identification in pleural infection, significantly increasing microbiological yield compared to standard methods.
Area of Science:
- Infectious Diseases
- Medical Imaging
- Microbiology
Background:
- Pleural infection, a common pneumonia complication, has high mortality and poor outcomes.
- Current treatment relies on broad-spectrum antibiotics due to infrequent pathogen identification.
- Ultrasound (US)-guided pleural biopsy culture was investigated to enhance microbiological yield.
Purpose of the Study:
- To assess the safety and significance of US-guided pleural biopsy culture in increasing microbiological yield.
- To evaluate the utility of the 16S ribosomal RNA technique for faster and more accurate diagnosis.
Main Methods:
- A feasibility interventional clinical study involving twenty patients with pleural infection.
- Participants underwent US scans and US-guided pleural biopsies before chest drain insertion.
- Pleural biopsies, pleural fluid, and blood samples were analyzed microbiologically; 16S rRNA technique was also applied.
Main Results:
- US-guided pleural biopsies were safe, with no adverse events.
- Microbiological yield increased by 25% with US-guided biopsies compared to standard samples.
- The 16S ribosomal RNA technique showed high sensitivity (93%) and specificity (89.5%) on biopsy samples.
Conclusions:
- US-guided pleural biopsies are safe and substantially increase microbiological diagnosis in pleural infection.
- This technique may reveal a potential niche of infection in pleural disease.
- Quantitative PCR on pleural fluid and biopsy shows excellent sensitivity and specificity.
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