Pneumonia is a major cause of morbidity in pts undergoing HSCT and AL therapy. Early FOB with culture, cytopath and viral ELISA testing improves survival. Early FOB at our center historically identified causative microorganism(s) in 37% of pts (68/183). We conducted an IRB approved prospective early FOB trial in 49 pts undergoing HSCT or AL therapy with respiratory symptoms and new radiographic lung infiltrates to determine the impact of the rapid PCR panel combined with culture testing. The PCR panel included Mycoplasma, Chlamydia, HSV, VZV, HHV7, RSV, hMPV, Rhino/Coronavirus, Adenovirus, Influenza A/B, Parainfluenza Type 1-3 and Aspergillus. The study was performed between 5/9/2011 and 9/1/2015 in 49 consecutive pts at a median of 106 days from treatment (4-1369): AL (14), autologous HSCT (4) and allogeneic HSCT (31). FOB was performed within 24 hours of diagnosis. Forty-eight, 37 and 16 pts were on anti-viral, anti-fungal prophylaxis and quinolone prophylaxis, respectively. Radiographs demonstrated new alveolar airspace/bronchogram (11); diffuse ground glass or interstitial (5); reticulonodular (19); nodular/cavitary (10), or single patchy (4) infiltrates. FOB results were positive in 40/49 patients (82%), with 24 positive cultures and 54 positive PCR tests. The airspace cohort had 7/11 positive bacterial or AFB/scedosporium (1) cultures with 5 concurrent positive viral and 1 Aspergillus PCR. The ground glass/reticulonodular cohorts had 19/24 positive viral PCR assays with polymicrobial viral infections in 6 pts, polymicrobial viral and bacterial infection in 2 and polymicrobial viral and fungal/yeast 4 pts. Aspergillus positive culture in 1 pt and by PCR in 1 pt. The nodular/cavitary cohort had 2 positive Aspergillus PCR, 1 MRSA, 1 MRSE, 1 Parainfluenza/hMPV, and 2 with colonization with HHV-7 with negative cultures. We conclude that the addition of molecular PCR testing to early FOB resulted in high identification of infectious pathogens and allowed rapid precision modification of antimicrobial therapy for the majority of patients.
| Microbiological Results in the Total of 40 Positive Bronchoscopies | |||
|---|---|---|---|
| Bacteria | |||
| Culture | N | PCR | N |
| S. pneumoniae | 1 | Legionella | 2 |
| Beta strep | 2 | ||
| MRSA | 1 | ||
| Moraxella | 1 | ||
| Klebsiella | 2 | ||
| Pseudomonas | 2 | ||
| Stenotrophmonas | 1 | ||
| Fungi | |||
| Candida Krusei | 1 | Aspergillus | 2 |
| Aspergillus | 1 | Pan-Aspergillus | 2 |
| Scedosporium | 1 | ||
| Penicillium | 1 | ||
| Scytalidium | 2 | ||
| Virus | |||
| Parainfluenza | 3 | Parainfluenza | 6 |
| CMV | 3 | hMPV | 1 |
| Rhinovirus | 12 | ||
| Adenovirus | 1 | ||
| HHV-7 | 23 | ||
| HSV-1 | 3 | ||
| HSV-2 | 1 | ||
| RSV | 1 | ||
| Mycobacteria | |||
| Mycobacterium gordonae | 1 | ||
| Mycobacterium avium-complex | 1 | ||