Evaluation of a multiplex PCR for bacterial pathogens applied to bronchoalveolar lavage

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Abstract
The present study assessed the diagnostic usefulness of a multiplex PCR (mPCR) forStreptococcus pneumoniae,Haemophilus influenzae,Mycoplasma pneumoniaeandChlamydophila pneumoniaeapplied to bronchoalveolar lavage (BAL).Fibreoptic bronchoscopy was performed on 156 hospitalised adult patients with lower respiratory tract infection (LRTI) and 36 controls. BAL fluid was analysed with bacterial culture and mPCR.By conventional diagnostic methods,S. pneumoniae,H. influenzae,M. pneumoniaeandC. pneumoniaewere aetiological agents in 14, 21, 3.2 and 0% of the LRTI patients, respectively. These pathogens were identified by BAL mPCR in 28, 47, 3.2 and 0.6% of cases, respectively, yielding sensitivities of 86% forS. pneumoniae, 88% forH. influenzae, 100% forM. pneumoniaeand 0% forC. pneumoniae, and specificities of 81, 64, 100 and 99% forS. pneumoniae,H. influenzae,M. pneumoniaeandC. pneumoniae, respectively. Of the 103 patients who had taken antibiotics prior to bronchoscopy,S. pneumoniaewas identified by culture in 2.9% and by mPCR in 31%. Among the controls, mPCR identifiedS. pneumoniaein 11% andH. influenzaein 39%.In lower respiratory tract infection patients, bronchoalveolar lavage multiplex PCR can be useful for identification ofStreptococcus pneumoniae,Mycoplasma pneumoniaeandChlamydophila pneumoniae. The method appears to be particularly useful in patients treated with antibiotics.

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