A Pilot Feasibility Study in Establishing the Role of Ultrasound-Guided Pleural Biopsies in Pleural Infection (The AUDIO Study)

Abstract

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. Quantitative polymerase chain reaction primer assessment of pleural fluid and biopsy appears to have excellent sensitivity and specificity.

Medical and Surgical Management of Empyema

“…31,63,67 The use of polymerase chain reaction (PCR) of 16S ribosomal RNA (rRNA) improves the diagnostic yield (82 vs. 55% with conventional cultures) 68 ; the bacteria identified solely by PCR are frequently anaerobes. 69,70 PCR technology can also be applied to tissue obtained from ultrasound-guided pleural biopsies, which increases the yield compared with conventional culture, again particularly for anaerobes. 70 However, the overall yield remains 55% despite combination testing (blood culture, pleural fluid culture, pleural fluid, and pleural biopsy 16S rRNA), 70 and PCR is not routinely available.…”

“…69,70 PCR technology can also be applied to tissue obtained from ultrasound-guided pleural biopsies, which increases the yield compared with conventional culture, again particularly for anaerobes. 70 However, the overall yield remains 55% despite combination testing (blood culture, pleural fluid culture, pleural fluid, and pleural biopsy 16S rRNA), 70 and PCR is not routinely available. Therefore, empiric antibiotics must often be guided by an understanding of the bacteria frequently encountered in specific settings.…”

“…82 When Strep pneumoniae is isolated from pleural fluid, it is usually the only organism, even when advanced diagnostic techniques are employed. 61,[68][69][70]79 This may be because pneumococcus proliferates rapidly in exudative pleural fluid, 83 perhaps thereby excluding other bacteria.…”

Pleural Biopsy to Capture Causative Microbe

“…This issue of CHEST features another exciting pilot project, the Advanced Ultrasound in Pleural Infection (AUDIO) study, which explored the benefits of obtaining pleural tissue specimens in patients with pleural infection. 5 This approach may provide an important jigsaw piece to advance scientific understanding and clinical care of this condition.…”

“…Psallidas et al 5 found that culture of pleural tissue specimens provided a much higher yield than pleural fluid or blood specimens, by 2.5-and 4.5-fold (45% vs 20% vs 10%), respectively, in 20 patients with suspected pleural infection. In 25% of patients, the pleural tissue was the only investigation that captured an organism.…”