Syndrome Evaluation System Contributes to Higher and Faster Pathogen Identification with Superior Clinical Correlation as Compared to Conventional Cultures in Patients with Empyema and Parapneumonic Effusions

• Main Authors: Natarajan Rajagopalan, Arun H Mahadevaiah, Toshit Sapkal, Dipanjan Chakraborty
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: The Journal of Association of Chest Physicians
• Subjects: Empyema; multiplex polymerase chain reaction; parapneumonic effusion; syndrome evaluation system
• Online Access: http://www.jacpjournal.org/article.asp?issn=2320-8775;year=2019;volume=7;issue=1;spage=10;epage=17;aulast=Rajagopalan

Background & Objective: Pleural fluid culture is the standard of diagnosis for infectious etiology in parapneumonic effusion and empyema. However, the sensitivity is poor in tertiary centers due to prior antibiotic therapy. Newer nonculture-based molecular diagnostics are emerging as effective alternatives for microbial diagnosis. This prospective study evaluates the efficacy of Syndrome Evaluation System (SES), a multiplex molecular diagnostic test, in establishing the microbial etiology of empyema and clinical correlations of SES results with severity, interventions, and outcomes. Materials and Methods: Pleural fluid samples from 31 adult patients clinically diagnosed with empyema/complicated parapneumonic effusion were subjected to routine culture and SES. Routine laboratory tests, imaging, and antibiotic therapy were instituted as per standard care. Results: SES had 2.6-fold higher detection rate as compared to pleural fluid culture. A total of 16 samples (52%) were positive for pathogens on SES, whereas only six samples (20%) were positive on culture. SES was 83.33% concordant with culture. SES results were available within 24 h as compared to >72 h for culture. Prevalence of Gram-negative bacteria was 73.1%. SES positives were significantly associated with severity of disease and need to conduct more invasive procedures like thoracotomy and decortication. SES negatives had superior clinical outcomes compared to SES positives. Conclusion: SES has higher yield in microbial diagnosis compared to standard culture. It is sensitive, specific, and provides valuable information regarding a number of clinical correlates associated with empyema and complicated parapneumonic effusion. SES opens up new possibilities in understanding pathogenesis, management, and outcome in empyema.