A pilot feasibility study in establishing the role of ultrasound-guided pleural biopsies in pleural infection (The AUDIO study).
Psallidas I., Kanellakis NI., Bhatnagar R., Ravindran R., Yousuf A., Edey AJ., Mercer RM., Corcoran JP., Hallifax RJ., Asciak R., Shetty P., Dong T., Piotrowska HEG., Clelland C., Maskell NA., Rahman NM.
BACKGROUND: Pleural infection is a common complication of pneumonia associated with high mortality and poor clinical outcome. Treatment of pleural infection relies on the use of broad-spectrum antibiotics, since reliable pathogen identification occurs infrequently. We performed a feasibility interventional clinical study assessing the safety and significance of ultrasound (US)-guided pleural biopsy culture to increase microbiological yield. In an exploratory investigation, the 16S rRNA technique was applied to assess its utility on increasing speed and accuracy versus standard microbiological diagnosis. METHODS: 20 patients with clinically established pleural infection were recruited. Participants underwent a detailed US scan and US-guided pleural biopsies before chest drain insertion, alongside standard clinical management. Pleural biopsies and routine clinical samples (pleural fluid and blood) were submitted for microbiological analysis. RESULTS: US-guided pleural biopsies were safe with no adverse events. US-guided pleural biopsies increased microbiological yield by 25% in addition to pleural fluid and blood samples. The technique provided a substantially higher microbiological yield compared to pleural fluid and blood culture samples (45% compared to 20% and 10% respectively). The 16S rRNA technique was successfully applied to pleural biopsy samples, demonstrating high sensitivity (93%) and specificity (89.5%). CONCLUSIONS: Our findings demonstrate the safety of US-guided pleural biopsies in patients with pleural infection and a substantial increase in microbiological diagnosis, suggesting potential niche of infection in this disease. qPCR primer assessment of pleural fluid and biopsy appears to have excellent sensitivity and specificity.