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Abstract citation ID: ofac492.410
332. Broad range PCR of pleural fluid improves diagnosis of bacterial pneumonia
complicated by parapneumonic effusion
Shankar Upadhyayula, MD, MRCPCH, FIDSA
1
;
1
Akron childrens hospital,
PENINSULA, Ohio
Session: 43. Diagnostics: Bacteriology/Mycobacteriology
Thursday, October 20, 2022: 12:15 PM
Background. Bacterial pneumonia complicated by a para pneumonic effusion is
frequently encountered in hospitalized patients. However, identifying the etiology of
pneumonia remains elusive. Published data report rates of bacteremia ranging from
13-26% among patients with pneumonia complicated by parapneumonic effusion.
Good quality sputum samples are difficult to obtain in children. Culture of pleural flu-
id is helpful, but most patients are already pretreated before a specimen is obtained
limiting utility. Nucleic acid assays of pleural fluid have reported sensitivities from
40-80%. We wanted to review our experience with pleural fluid nucleic acid assay
at Akron childrens hospital
Methods. Using help from our laboratory data support team, we retrospectively
reviewed the records of all pleural fluid isolates that were sent out to Washington
University Medical Center for 16 S rRNA sequencing (broad range polymerase chain
reaction assay). The review covered a 8-year time period ranging from January 2014 to
March 2022. Negative blood and pleural fluid cultures were a prerequisite before the
send out for nucleic acid assay.
Results. A total of 29 pleural fluid samples were sent out for 16S rRNA sequenc-
ing. 22 of these had a detectable target. This translated into a yield of about 75%. The
following table summarizes our findings.
Conclusion. In our experience, nucleic acid assay of the pleural fluid is valuable
in making a bacteriological diagnosis of pneumonia with para pneumonic effusion. Its
benefit remains in patients pretreated with antibiotics. For the individual patient it
may help narrow antibiotic therapy. At an institutional level it would allow for devel-
oping guidelines for empiric antibiotic management. However, in most institutions’
nucleic acid assay of pleural fluid remains a send out test and optimizing workflows
to reduce turnaround time remains a challenge.
Disclosures. All Authors: No reported disclosures.
S218 •OFID 2022:9 (Suppl 2) •Poster Abstracts
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