Rapid Site Evaluation Of The Pathogens In Patients With Severe Community-acquired Pneumonia

Objective: To explore the rapid site evaluation of pathogens in terms of chest HRCT findings and tracheoscopic abnormality among patients with severe community acquired pneumonia(SCAP).Methods: The patients with SCAP admitted to Department of Respiratory Intensive Care Unit(ICU)of the First Affiliated Hospital of Xinjiang Medical University from August 2018 to September 2019 were recruited.All patients meeting the diagnostic criteria of SCAP in Chinese guidelines for the diagnosis and treatment of community-acquired pneumonia in adults(2016 edition).The patients' infectious pathogens were rapidly supposed according to their chest CT findings and tracheoscopic abnormality.30-40 ml of bronchoalveolar lavage fluid(BALF)was collected to perform the routine pathogenic tests and next generation sequencing(NGS).The confirmed diagnosis of responsible pathogens is mainly based on the results of NGS,and refer to the results of routine pathogenic tests of BALF.Results: 27 patients with SCAP were included in the study.According to the results of BALF' NGS and routine pathogenic tests,pneumonia due to invasive fungal infection(IFI)occurred in 12 cases(44.5%),bacterial ones in 7 cases(25.9%),viral ones in 4(14.8%),and pulmonary tuberculosis in 4 cases(14.8%),respectively.While chest HRCT findings combined with bedside tracheoscopic abnormality rapidly assess SCAP pathogens,the consistent rate of rapid assessment results of lung IFI compared with confirmed diagnosis results was 81.48%(22/27),with a Kappa value of 0.628(P=0.001);the consistent rate of bacterial infection was 81.48%(22/27),with a Kappa value of 0.577(P =0.002).Conclusion:Chest HRCT findings combined with bedside tracheoscopic abnormality can quickly assess SCAP pathogens.The fungal infections and bacterial infections have a good consistency with the results of BALF' NGS and routine pathogenic tests,and can provide evidence for early empirical treatment.