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The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients()
INTRODUCTION: Pulmonary infiltrates in immunosuppressed patients are common. Yields from bronchoscopy with bronchoalveolar lavage (BAL) has been reported to be between 31 and 65%. The clinical impact of pneumocystis and viral Polymerase chain reaction (PCR) testing on BAL has not been extensively ev...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126456/ https://www.ncbi.nlm.nih.gov/pubmed/30509714 http://dx.doi.org/10.1016/j.rmed.2018.10.021 |
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author | Lachant, Daniel J. Croft, Daniel P. McGrane Minton, Heather Hardy, Dwight J. Prasad, Paritosh Kottmann, R. Matthew |
author_facet | Lachant, Daniel J. Croft, Daniel P. McGrane Minton, Heather Hardy, Dwight J. Prasad, Paritosh Kottmann, R. Matthew |
author_sort | Lachant, Daniel J. |
collection | PubMed |
description | INTRODUCTION: Pulmonary infiltrates in immunosuppressed patients are common. Yields from bronchoscopy with bronchoalveolar lavage (BAL) has been reported to be between 31 and 65%. The clinical impact of pneumocystis and viral Polymerase chain reaction (PCR) testing on BAL has not been extensively evaluated in a mixed immunosuppressed patient population. METHODS: We performed a retrospective chart review of immunosuppressed adults with pulmonary infiltrates who underwent BAL at the University of Rochester Medical Center. Only one BAL per patient was included. We compared the rate of positive PCR testing to conventional testing. We then investigated factors associated with positive PCR testing. Finally, we assessed for changes in antimicrobial therapy after bronchoscopy. RESULTS: Three hundred and fifty-nine patients underwent BAL with 249 patients having pneumocystis PCR testing and 142 having viral PCR testing. Pneumocystis identification occurred in 43 patients and viral species identification occurred in 56 patients. PCR testing increased pneumocystis identification compared to microscopy, 14% vs. 5%, p = 0.01, and viral identification compared to culture, 25% vs. 6%, p = 0.0001. Of the patients with positive pneumocystis PCR testing 49% had antibiotics stopped, 66% were started on anti-pneumocystis therapy, and only 6% did not receive treatment. There was no difference in the number of patients with antibiotics stopped based on viral PCR testing results. DISCUSSION: PCR testing increases BAL yield in immunosuppressed patients compared to conventional testing. Pneumocystis identified by PCR only may cause a self-limited infection and may not require antimicrobial therapy. PCR testing should be included in the evaluation of pulmonary infiltrates in immunosuppressed patients. |
format | Online Article Text |
id | pubmed-7126456 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Elsevier Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-71264562020-04-08 The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() Lachant, Daniel J. Croft, Daniel P. McGrane Minton, Heather Hardy, Dwight J. Prasad, Paritosh Kottmann, R. Matthew Respir Med Article INTRODUCTION: Pulmonary infiltrates in immunosuppressed patients are common. Yields from bronchoscopy with bronchoalveolar lavage (BAL) has been reported to be between 31 and 65%. The clinical impact of pneumocystis and viral Polymerase chain reaction (PCR) testing on BAL has not been extensively evaluated in a mixed immunosuppressed patient population. METHODS: We performed a retrospective chart review of immunosuppressed adults with pulmonary infiltrates who underwent BAL at the University of Rochester Medical Center. Only one BAL per patient was included. We compared the rate of positive PCR testing to conventional testing. We then investigated factors associated with positive PCR testing. Finally, we assessed for changes in antimicrobial therapy after bronchoscopy. RESULTS: Three hundred and fifty-nine patients underwent BAL with 249 patients having pneumocystis PCR testing and 142 having viral PCR testing. Pneumocystis identification occurred in 43 patients and viral species identification occurred in 56 patients. PCR testing increased pneumocystis identification compared to microscopy, 14% vs. 5%, p = 0.01, and viral identification compared to culture, 25% vs. 6%, p = 0.0001. Of the patients with positive pneumocystis PCR testing 49% had antibiotics stopped, 66% were started on anti-pneumocystis therapy, and only 6% did not receive treatment. There was no difference in the number of patients with antibiotics stopped based on viral PCR testing results. DISCUSSION: PCR testing increases BAL yield in immunosuppressed patients compared to conventional testing. Pneumocystis identified by PCR only may cause a self-limited infection and may not require antimicrobial therapy. PCR testing should be included in the evaluation of pulmonary infiltrates in immunosuppressed patients. Elsevier Ltd. 2018-12 2018-10-22 /pmc/articles/PMC7126456/ /pubmed/30509714 http://dx.doi.org/10.1016/j.rmed.2018.10.021 Text en © 2018 Elsevier Ltd. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Lachant, Daniel J. Croft, Daniel P. McGrane Minton, Heather Hardy, Dwight J. Prasad, Paritosh Kottmann, R. Matthew The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title | The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title_full | The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title_fullStr | The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title_full_unstemmed | The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title_short | The clinical impact of pneumocystis and viral PCR testing on bronchoalveolar lavage in immunosuppressed patients() |
title_sort | clinical impact of pneumocystis and viral pcr testing on bronchoalveolar lavage in immunosuppressed patients() |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7126456/ https://www.ncbi.nlm.nih.gov/pubmed/30509714 http://dx.doi.org/10.1016/j.rmed.2018.10.021 |
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