Biofire Filmarray下呼吸道试剂盒在危重症新型冠状病毒肺炎继发感染患者中的应用效果评价

Value of Biofire Filmarray Pneumonia Panel in Evaluating Secondary Infection in Critically Ill Patients with Coronavirus Disease 2019

目的探讨Biofire Filmarry下呼吸道试剂盒(pneumonia panel, PN)在危重症COVID-19继发感染患者中的应用效果。方法回顾性分析2020年2月至4月武汉同济医院中法新区ICU危重症COVID-19患者的临床资料。经支气管镜获取患者肺泡灌洗液后分别送检Biofire Filmarray PN/普通培养,比较两种方法的检测结果,并计算其一致率。结果共21例符合纳入标准的危重症COVID-19患者入选本研究,送检下呼吸道标本54份,包括Biofire Filmarray PN组21例患者33份(61.1%)标本、普通培养组14例患者21份(38.9%)标本,其中19对(共38份)为两种方法"背靠背"送检。Biofire Filmarray PN组结果回报时间约为1 h,20例患者32份(97.0%)阳性标本,检出病原体74例次,其中鲍曼不动杆菌复合体29例次(39.2%),铜绿假单胞菌21例次(28.4%),肺炎克雷伯菌16例次(21.6%),大肠杆菌5例次(6.8%),阴沟肠杆菌、流感嗜血杆菌及呼吸道合胞病毒各1例次(1.4%)。普通培养组结果回报时间约为3 d,11例患者16份(76.2%)阳性标本,检出病原体19例次,其中为铜绿假单胞菌8例次(42.1%),鲍曼不动杆菌6例次(31.6%),嗜麦芽窄食单胞菌4例次(21.1%),粘金黄杆菌1例次(5.3%)。19对"背靠背"送检标本中,Biofire Filmarray PN组和普通培养组结果吻合者为15对,一致率为78.9%。结论危重症COVID-19患者易继发感染,病原体以鲍曼不动杆菌复合体、铜绿假单胞菌多见。Biofire Filmarray PN可用于此类患者的下呼吸道病原学诊断,具有回报速度快的优势,但其灵敏度需大样本研究进一步验证。

Objective To explore the application value of Biofire Filmarry pneumonia panel(PN) indetection of secondary and concomitant pathogen among critically ill patients with coronavirus disease 2019(COVID-19). Methods We consecutively included and analyzed the clinical data of critically ill patients with COVID-19 transferred to the ICU from February to April 2020 in the Sino-French Campus of Wuhan Tongji Hospital. Samples of Bronchoalveolar lavage fluid obtained by bedside bronchoscopy were sent for Biofire Filmarray PN and standard culture concomitantly. We compared the results of two methods and evaluated their concordance. Results In total, 21 critically ill patients with COVID-19 were included and 54 samples were tested, including 33(61.1%) Biofire Filmarray PN tests(21 patients) and 21(38.9%) standard cultures(14 patients), in which 19 pairs(38 samples) underwent both tests simultaneously. In Biofire Filmarray PN group, the turnaround time was about 1 hour. There were 74 positive results in 32 samples(97.0%) from 20 patients, including 29 cases(39.2%) of Acinetobacter baumannii complex, 21 cases(28.4%) of Pseudomonas aeruginosa, 16 cases(21.6%)of Klebsiella pneumoniae, 5 cases(6.8%) of Escherichia coli, 1 case(1.4%)each of Enterobacter cloacae, Haemophilus influenzae, and respiratory syncytial virus. In the standard culture group, the turnaround time was about 3 days. 19 positive results returned in 16(76.2%) samples from 11 patients, including 8 cases(42.1%) of Pseudomonas aeruginosa, 6 cases(31.6%) of Acinetobacter baumannii, 4 cases(21.1%) of Stenotrophomonas malt and 1 case(5.3%) of Myxobacterium. Among the 19 pairs of "back-to-back" specimens, 15 pairs were concordant, and the agreement ratio was 78.9%. Conclusions Acinetobacter baumannii and Pseudomonas aeruginosa may be the common pathogens of secondary or concomitant infection in critically ill patients with COVID-19. Biofire Filmarray PN is a rapid diagnostic test and has application value in such patients;its sensitivity and accuracy require further investigation with larger sample sizes.