Improved sensitivity for respiratory pathogen detection in bronchoalveolar lavage from lung transplant recipients...

Next-generation sequencing (NGS) can improve pathogen detection in pulmonary infections among lung transplant recipients (LTRs). Here, NGS was retrospectively compared to conventional cultures (CC) in parallel bronchoalveolar lavage (BAL) specimens from LTRs. Positivity rates were compared using sensitivity and specificity relative to a composite reference for infection. NGS species-level diagnostic accuracy was assessed against culture as reference. In total, 122 bronchoscopies from 31 LTRs were included. Compared to infection, broad-range sensitivity of CC was 50.5% (95% confidence interval [CI], 35.6% to 65.4%), which was lower than NGS at 74.2% (95%CI, 64.0% to 2.3%, p=0.0016) and NGS+CC at 77.4% (95%CI, 66.0% to 85.8%). However, NGS specificity was lower at 86.2% (95%CI, 66.6% to 95.1%) compared to CC at 100% (95%CI, 100% to 100%, p=0.049). For pathogens detected by CC, NGS had a pooled sensitivity, specificity, and accuracy of 82.1%, 98.7%, and 98.6%, respectively. In conclusion, adding NGS improves microbiologic workups for pulmonary infection in immunocompromised patients after lung transplantation.