Pleural infections cause major morbidity and mortality, particularly amongst paediatric and elderly populations. The aetiology is broad, but pleural culture fails to yield a causative pathogen in approximately 40 % of cases. Alternative pathogen identification methods are therefore required. The aim of the study was to investigate the yield from and impact on patient care when performing 16S rRNA PCR on culture-negative pleural fluid specimens and to determine whether any individual laboratory parameters were associated with a positive 16S rRNA PCR result. We conducted a study on 90 patients with suspected pleural infection, who had a culture-negative pleural fluid specimen, which underwent 16S rRNA PCR analysis between August 2017 and June 2019. This study was undertaken at a large NHS Trust in London, UK. Thirty-one per cent of culture-negative pleural fluid specimens tested by 16S rRNA PCR yielded a positive PCR result. Our data demonstrated that 16S rRNA PCR detected a significantly higher proportion of Streptococcus pneumoniae (P<0.0001) and fastidious, slow-growing and anaerobic pathogens (P=0.0025) compared with culture-based methods. Of the 25 16S rRNA PCR results that were positive for a causative pathogen, 76 % had a direct impact on clinical management. No single laboratory variable was found to be associated with a positive 16S rRNA PCR result. The findings from our real-world evaluation highlight the importance of 16S rRNA PCR in confirming pleural infection when the aetiology is unknown, and its direct, positive impact on clinical management.

中文翻译：

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16S rRNA PCR在胸膜感染中的临床应用。

胸膜感染导致主要的发病率和死亡率，尤其是在儿科和老年人口中。病因广泛，但在大约40％的病例中，胸膜培养未能产生病原体。因此，需要替代的病原体鉴定方法。该研究的目的是调查在培养阴性的胸水样本上进行16S rRNA PCR时产生的收率及其对患者护理的影响，并确定是否有任何单独的实验室参数与16S rRNA PCR阳性结果相关。我们对90名疑似胸膜感染的患者进行了研究，这些患者的胸膜培养液阴性，并于2017年8月至2019年6月之间进行了16S rRNA PCR分析。该研究在英国伦敦的NHS大型信托基金中进行。通过16S rRNA PCR检测的培养阴性胸水样本中有31％产生了阳性PCR结果。我们的数据表明16S rRNA PCR检测到显着更高的比例 与基于培养的方法相比，肺炎链球菌（ P <0.0001）以及挑食性，缓慢生长和厌氧性病原体（ P = 0.0025）。在25个针对病原体呈阳性的16S rRNA PCR结果中，有76％对临床管理产生了直接影响。没有发现单个实验室变量与阳性16S rRNA PCR结果相关。我们在现实世界中的评估结果突显了16S rRNA PCR在病因不明时确认胸膜感染的重要性及其对临床管理的直接积极影响。