The Detection of Causative Agents With Rapid Molecular Biological Medhods in Late Onset Hospital Acquired Pneumonia

• Main Authors: Ahmet UYSAL, Mehmet Sezai TAŞBAKAN, Şöhret AYDEMİR, Hüsnü PULLUKÇU, Feriha ÇİLLİ, Feza BACAKOĞLU
• Format: Article
• Language: English
• Published: Bilimsel Tip Yayinevi 2021-03-01
• Series: Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
• Subjects: hospital-acquired pneumonia; bacterial agents; rapid molecular methods; polymerase chain reaction (pcr)
• Online Access: http://www.floradergisi.org/managete/fu_folder/2021-01/78-87%20Ahmet%20Uysal.pdf

Introduction: Late-onset hospital-acquired pneumonia (HAP) developing after the fifth day following admission to the hospital is usually caused by multi-drug resistant bacteria. Late detection of the agents and failure in starting the appropriate antibiotic treatment timely negatively affect HAP prognosis. Isolating infectious microorganisms in a short time by fast molecular methods in the last years has ensured that treatment can be started earlier and more effectively, which is thought to affect prognosis positively. In this study, it was aimed to determine the factors in HAP with rapid molecular methods and to compare the results with conventional methods. Materials and Methods: A total of 62 patients diagnosed with HAP according to the criteria of ATS/IDSA published in 2005 and followed-up in the intensive care units of Anesthesia and Reanimation Department and Chest Disease Departments between January 2014 and January 2016 were included into the study. Lower respiratory tract samples were obtained from patients after HAP diagnosis with bronchoscopic (bronchoalveolar lavage (BAL), bronchoscopic aspiration (BASP) and non-bronchoscopic (mini-BAL) methods. The samples were examined in terms of bacteriological agents with conventional methods and fast molecular methods. Results: Sixty-two patients (42 males, mean age: 69.7 ± 15.6) diagnosed with hospital-acquired pneumonia were included. Ninety-five point two percent of the patients had a comorbid disease. Invasive mechanical ventilation (IMV) was applied to 33 patients and non-invasive mechanical ventilation (NIV) was applied to 28 patients. In a total of 62 patients conventional methods and polymerase chain reaction (PCR) were used to detected in 40 (64.5%) and in 57 (91.9%) patients, respectively. It was observed that the conventional method and the PCR method were compatible with each other in terms of detecting the agent (kappa: 0.797). Besides, PCR was found to have a significantly higher rate of agent detection (p= 0.0004). Acinetobacter baumannii was detected most frequently with both methods. In the follow-up, mortality was observed in 45 (72.6%) of the 62 patients. Conclusion: As a result, it was shown in this study that there is a good agreement between conventional methods and PCR in the detection of late-onset HAP agents and that agents can be detected by PCR in more patients.