Rapid molecular detection of airway pathogens in lung transplant recipients.
Rapid molecular detection of airway pathogens in lung transplant recipients.
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DOI：
10.1111/tid.13579
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Greenland JR
中科院分区：
文献类型：
--
作者：
Hoover J;Mintz MA;Deiter F;Aminian E;Chen J;Hays SR;Singer JP;Calabrese DR;Kukreja J;Greenland JR
肺移植受者的呼吸道感染很难与急性排斥反应区分开来。传统的养殖技术需要时间，这可能会延误治疗。我们假设，快速的多重分子检测可以缩短诊断时间和做出适当的临床决策。在一项对接受支气管镜检查的患者进行的前瞻性观察性研究中，我们在进行标准护理(SOC)诊断的同时评估了BioFire®FilmArray®肺炎小组(BFPP)。研究临床医生实时执行影子(仅研究)临床决策。报告时间和口译时间以中位数和四分位数范围报告，并通过Wilcoxon符号排名检验进行比较。协议的定义是基于检测到分子检测中的任何目标物种。对于150名登记的受试者，支气管镜检查后3.8小时(IQR2.8-5.1)可以得到BFPP结果，相比之下，病毒性SOC(IQR10-34，P<；0.001)结果是13小时，细菌SOC(IQR46-70，P<；0.001)结果是48小时。支气管镜检查后9小时(IQR5-20)内判断为BFPP阳性，而SOC为74小时(IQR37-110，P<；0.001)。在150名受试者中，138人(92%)的检测结果符合要求。在22例BFPP诊断中，5例(23%)结果为影子抗生素推荐。值得注意的BFPP缺陷包括真菌和副流感嗜血杆菌，分别占56个可操作的SOC结果中的15个(27%)和13个(23%)。这种包括细菌靶点的分子诊断方法有可能缩短诊断时间，增加当前的临床决策，但不能取代SOC培养方法。NCT03933878
Airway infections are difficult to distinguish from acute rejection in lung transplant recipients. Traditional culture techniques take time that may delay treatment. We hypothesized that a rapid multiplex molecular assay could improve time to diagnosis and appropriate clinical decision making. In a prospective observational study of recipients undergoing bronchoscopy, we assessed the BioFire® FilmArray® Pneumonia Panel (BFPP) in parallel to standard of care (SOC) diagnostics. Research clinicians performed shadow (research only) clinical decision making in real time. Time to report and interpretation were reported as median and interquartile ranges and compared by Wilcoxon signed-ranked test. Agreement was defined based on detection of any species targeted in the molecular assay. For the 150 enrolled subjects, BFPP results were available 3.8 hours (IQR 2.8–5.1) following bronchoscopy, compared to 13 hours for viral SOC (IQR 10–34, P <0.001) results and 48 hours for bacterial SOC (IQR 46–70, P <0.001) results. Positive BFPP were interpreted in 9 hours (IQR 5–20) following bronchoscopy, compared to 74 hours for SOC (IQR 37–110, P <0.001). Assays agreed for 138 (92%) of the 150 subjects. Of 22 BFPP diagnoses, 5 (23%) resulted in a shadow antibiotic recommendation. Notable BFPP deficiencies included fungal species and H. parainfluenzae, accounting for 15 (27%) and 13 (23%) of the 56 actionable SOC results, respectively. This molecular diagnostic including bacterial targets has the potential to shorten time to diagnosis and augment current clinical decision making but cannot replace SOC culture methods. NCT03933878
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