• Ioannis Psallidas, Nikolaos I Kanellakis, Rahul Bhatnagar, Rahul Ravindran, Ahmed Yousuf, Anthony J Edey, Rachel M Mercer, John P Corcoran, Robert J Hallifax, Rachelle Asciak, Prashanth Shetty, Tao Dong, PiotrowskaHania E GHEGOxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK., Colin Clelland, Nick A Maskell, and Najib M Rahman.
• Oxford 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. Electronic address: ioannis.psallidas@ndm.ox.ac.uk.
• Chest. 2018 Oct 1; 154 (4): 766772766-772.

BackgroundPleural 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.MethodsTwenty 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.ResultsUS-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%).ConclusionsOur 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.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

24 keywords...

hide…