title: Impact of bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit.
abstract: OBJECTIVE
  The purpose of the study is to evaluate the impact of adding bronchoalveolar lavage multiplex polymerase chain reaction (M-PCR) to conventional cultures (CC) on microbiological yield and therapeutic decisions in adult intensive care unit patients with pneumonia and severe sepsis or septic shock.
  
  
  METHODS
  In this retrospective case-control study, bronchoalveolar lavage cultures were taken for control (58 patients, 58 admissions) and study arms (57 patients, 58 admissions). Bronchoalveolar lavage M-PCR was sent simultaneously for the latter.
  
  
  RESULTS
  A total of 267 microorganisms were identified (M-PCR alone, 211; CC alone, 15; both, 41) in the study arm vs 64 in controls. Concordance between M-PCR and culture was complete in 32 (55.17%), partial in 4 (6.9%), and discordant in 22 (37.93%) including 17 with positive M-PCR but negative CC. Time to antibiotic therapy modification was significantly less (P < .001) in M-PCR group compared to controls (32.40 ± 14.41 vs 41.74 ± 45.61 hours). There was no significant difference in index episode resolution (48.3% vs 50%; P = 1), intensive care unit mortality (57.4% vs 51.2%; P = .67), and hospital mortality (59.6% vs 61.5%; P = 1) in study and control arms, respectively, despite more septic shock patients in the study arm (89.7% vs 75.9%; P = .05).
  
  
  CONCLUSIONS
  Bronchoalveolar lavage M-PCR with culture leads to higher microbiological yield and earlier modification of antibiotics compared to conventional culture.
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: mrinal.sircar@fortishealthcare.com.
authors.forename: Mrinal
authors.initials: M
authors.lastname: Sircar
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: docranjan@gmail.com.
authors.forename: Prashant
authors.initials: P
authors.lastname: Ranjan
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: drrajeshgupta2387@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India.
authors.forename: Onkar Kumar
authors.initials: OK
authors.lastname: Jha
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: amitguptaicu@gmail.com.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: SRL Diagnostics, Fortis Hospital, Noida, India. Electronic address: ravneetkaur168@gmail.com.
authors.forename: Ravneet
authors.initials: R
authors.lastname: Kaur
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: dr_neela_c@yahoo.com.
authors.forename: Neela
authors.initials: N
authors.lastname: Chavhan
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: dr_mukta@rediffmail.com.
authors.forename: Mukta
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Pulmonology and Critical Care Medicine, Fortis Hospital, Noida, Uttar Pradesh, India. Electronic address: sujeetsinghfortis@gmail.com.
authors.forename: Sujeet Kumar
authors.initials: SK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000235:genetics* / Q000302:isolation & purification; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016022:Case-Control Studies; D046508:Culture Techniques / Q000379:methods; D005260:Female; D005658:Fungi / Q000235:genetics* / Q000302:isolation & purification; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction / Q000379:methods*; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D012772:Shock, Septic / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014780:Viruses / Q000235:genetics* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bronchoalveolar lavage; Multiplex PCR; Pneumonia; Septic shock; Severe sepsis