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Pleural fluid agitation for improving the microbiologic diagnostic yield in pleural infection: a feasibility study
Ahmed Sadaka1, Reda Said2, Heba Ashmawy2
1Department of Chest Diseases, Alexandria University Faculty of Medicine, Alexandria (Egypt), El- Khartoum Square, Alexandria, 21526, Egypt. ahmad.sadaka@alexmed.edu.eg.
Background:
Pleural infection is a commonly encountered respiratory disease but in > 40% the underlying microbiologic etiology is unknown. This feasibility study aims to investigate whether pleural fluid agitation prior to sample aspiration is safe and can improve the diagnostic yield of microbiologic analysis.
Methods:
Thirty adult patients with pleural infection, based on clinical, imaging and biochemical evidence, were included in this feasibility study. Ultrasound guided thoracentesis was performed with an initial standard aspiration sampling technique, followed by pleural fluid agitation into the pleural cavity for 3-5 cycles before collecting the agitated fluid. Coded samples were sent for biochemical and microbiologic analysis with culture in aerobic and anaerobic media.
Results:
No complications were encountered with the pleural fluid agitation technique. Overall, 14 (46.6%) of patients had a positive pleural fluid culture. No yield discordance was noted between the standard and the agitated pleural fluid sampling techniques except for 1 extra agitated sample growing klebsiella pneumoniae and another agitated sample with mixed infection showing an additional anaerobic bacterial growth. Four (30.8%) of the 13 concordantly positive samples showed heavier bacterial growth in the agitated samples using semi-quantitative culture scoring.
Conclusion:
Pleural fluid agitation was safe but didn't significantly add to the microbiologic yield in pleural infection. However, higher bacterial growth in almost one third of positive samples suggests a potential effect for further investigation in a larger study. Despite being safe, pleural fluid agitation resulted in no significant improvement in the microbiologic yield among pleural infection. However, agitated samples grew more bacteria in almost a third of the positive samples suggesting a signal for further investigation in a larger study.
Study Registration:
Clinicaltrials.gov - NCT05702580, 23/12/2022.
Insights
Pleural fluid agitation is a safe technique for diagnosing pleural infection, but it did not significantly improve overall microbiologic yield. However, it showed potential for increased bacterial growth in nearly a third of positive samples, warranting further study.
Area of Science:
- Respiratory Medicine
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Pleural infection is common, with unknown causes in over 40% of cases.
- Current diagnostic methods for pleural infection have limitations in identifying the causative microorganisms.
- Feasibility of novel techniques to improve diagnostic yield is crucial.
Purpose of the Study:
- To assess the safety and diagnostic yield of pleural fluid agitation before aspiration in patients with pleural infection.
- To determine if this technique enhances the detection of microorganisms compared to standard aspiration.
- To provide preliminary data for a larger-scale investigation.
Main Methods:
- A feasibility study involving 30 adult patients diagnosed with pleural infection.
- Ultrasound-guided thoracentesis with standard aspiration followed by pleural fluid agitation.
- Analysis of agitated and standard samples for biochemical and microbiologic (aerobic/anaerobic culture) parameters.
- Semi-quantitative culture scoring to assess bacterial load.
Main Results:
- Pleural fluid agitation was safe, with no complications reported.
- Overall positive culture yield was 46.6%, with no significant difference between standard and agitated samples.
- Agitated samples showed increased bacterial growth in 30.8% of positive cases and identified additional organisms in two instances.
- Klebsiella pneumoniae and additional anaerobic bacteria were identified in agitated samples.
Conclusions:
- Pleural fluid agitation is a safe adjunctive technique in the diagnostic workup of pleural infection.
- While not significantly improving overall diagnostic yield, it demonstrated potential for enhanced bacterial detection.
- Further investigation in larger studies is recommended to explore its utility in improving microbiologic diagnosis.
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