• Eva Tschiedel, Arkadius Goralski, Jörg Steinmann, Peter-Michael Rath, Margarete Olivier, Uwe Mellies, Tanja Kottmann, and Florian Stehling.
• Department of Pediatrics I, University Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. eva.tschiedel@uk-essen.de.
• BMC Pulm Med. 2019 Jul 18; 19 (1): 132.

BackgroundCulturing of bronchoalveolar lavage (BAL) fluid is a commonly used method for pathogen detection in pneumonia. However, the sensitivity is low, especially in patients pre-treated with anti-infective agents. The early detection of a pathogen is crucial for the outcome of respiratory tract infections. For bloodstream infections, a multiplex polymerase chain reaction (PCR) assay (SeptiFast®, SF) is available for improved pathogen detection from blood.ObjectiveThe aim of the present study was to determine whether the SF assay is applicable to the BAL of children with pulmonary infections and whether the frequency of pathogen detection is enhanced by the use of this multiplex PCR method.MethodsWe investigated 70 BAL samples of 70 children simultaneously by culture and multiplex PCR. The frequency of pathogen detection was compared.ResultsPathogens were detected more frequently by SF than by culture (83% vs. 31%; p < 0.001). This advantage was shown for immunocompetent patients (p = 0.001) as well as for immunocompromised patients (p = 0.003). The majority (38/44; 86%) of the Gram positive cocci were only detected by SF. Fungal organisms were detected in 7/70 patients (10%) by SF and in 2/70 (3%) by culture (p = 0.125).ConclusionCompared to conventional culture, the use of the SF assay on the BAL of children with pneumonia increases pathogen detection rates and therefore adds important information to guide anti-infective therapy.

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