Comparative analysis of the results of bacteriological and chromato-mass-spectrometric studies of pleural exudate in patients with pleural empyema

The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.

METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.

RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.

CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement.

1. Bisenkov L. N., Chuprina A. P., Gladyshev D. V. Vozmozhnosti torakoskopii pri empieme plevry. Materialy XIII Natsional’nogo kongressa po boleznyam organov dykhaniya. 2003:43. (In Russ.).

2. Ionov P. M., Elikin А. V., Deinega I. V., Yakovlev G. A., Shevtsova М. А. Etiology and clinical forms of lungs and pleura suppurative diseases of HIV-infected patients. Grekov’s Bulletin of Surgery. 2019;178(4):10–14. (In Russ.).

3. Farjah F., Symons R. G., Krishnadasan B., Wood D. E., Flum D. R. Management of pleural space infections: a population-based analysis. J. Thorac. Cardiovasc. Surg. 2007;133(2):346–351.

4. Amarantov A. G., Khorinko A. V., Kosareva P. V. Etiology, clinical picture, diagnosis and treatment of pleural empyema. Current notion (review of literature). Journal of ural medical academic science. 2016;3:61–74. (In Russ.).

5. Petukhov V. I., Rusetskaya M. O. Kliniko-laboratornaya diagnostika i lechenie gnoinykh zabolevanii legkikh i plevry. Vestnik Vitebskogo gosu darstvennogo medicinskogo universiteta. 2009;8(4):1–12. (In Russ.).

6. Danielyan Sh. N., Abakumov M. M., Chernenkaya T. V. Septic complications of the closed thoracic trauma. Khirurgiia. Zhurnal imeni N. I. Pirogova. 2011;3:19–25. (In Russ.).

7. Kubrakov K. M., Abodovsky S. A., Podolinsky Y. S., Ermashkevich S. N., Chulkov A. A. The antibiotic resistance of pleural empyema pathogens. Vestnik Vitebskogo gosudarstvennogo meditsinskogo universiteta. 2016;15(6):54–61. (In Russ.).

8. Ivanov F. V., Ivchenko E. V., Kotiv B. N., Barinov O. V., Suborova T. N. Effectiveness of rational antibacterial therapy in patients with pleural empyema under conditions of medical institutions. Vestnik Rossiiskoi voenno-meditsinskoi akademii. 2012;4:8–11. (In Russ.).

9. Wallet F., Nseir S., Baumann L., Herwegh S., Sendid B., Boulo M., Roussel-Delvallez M., Durocher A. V., Courcol R. J. Preliminary clinical study using a multiplex real-time PCR test for the detection of bacterial and fungal DNA directly in blood. Clin. Microbiol. Infect. 2010;16(6):774–779.

10. Schmidt V., Jarosch A., März P., Sander C., Vacata V., Kalka-Moll W. Rapid identification of bacteria in positive blood culture by matrixassisted laser desorption ionization time-of-flight mass spectrometry. Eur. J. Clin. Microbiol. Infect. Dis. 2012;31(3):311–317.

11. Osipov G. A., Fedosova N. F., Lyadov K. V. Kolichestvennyi in situ mikrobiologicheskii analiz po lipidnym markeram v biologicheskikh zhidkostyakh s ispol’zovaniem metoda gazovoi khromatografii-mass-spektrometrii. Zdravookhranenie i meditsinskie tekhnologii. 2007;5:20–23. (In Russ.).

12. Zhevelik O. D., Shmigol’ M. V. Primenenie metoda mass-spektrometrii mikrobnykh markerov pri septicheskom sostoyanii. Zdravookhranenie Yugry: opyt i innovatsii. 2019;2:35–36. (In Russ.).

13. Kolmyk V. A., Nasyrov R. A., Kutusheva G. F. Sravnitel’nyi analiz immunogistokhimicheskogo i khromatomassspektrometricheskogo issledovanii v diagnostike etiologicheskogo faktora khronicheskogo endometrita. Medicine: theory and practice. 2019;4:267–268. (In Russ.).

14. Strukova E. G., Efremov A. A., Gontova A. A., Osipov G. A., Sarmatova N. I. Definition of the Microecological Status and Diagnosis of the Human’s Infections, using the Method of Chromato-Mass-Spectrometry Journal of Siberian Federal University: Chemistry. 2009;4:351–357. (In Russ.).

15. Beloborodova N. V., Osipov G. A. Small molecules originating from microbes (SMOM) and their role in microbes-host relationship. Microbial ecology in Health and Disease. 2000;12(1):12–21.

16. Kiselev V. V., Andreitseva O. I., Boiko N. B., Osipov G. A., Fedosova N. F., Lyadov K. V. The microecological status of candidates for liver transplantation. Transplantologiya. 2010;1:37–45. (In Russ.).