Broad-range bacterial polymerase chain reaction in the microbiologic diagnosis of complicated pneumonia

被引:14
作者
Gollomp, Kandace [1 ]
Rankin, Shelley C. [2 ]
White, Caitlin [1 ]
Mattei, Peter [3 ,4 ]
Harris, Mary C. [5 ,6 ]
Kilpatrick, Laurie E. [7 ,8 ]
Sheffler-Collins, Seth [1 ]
McGowan, Karin L. [9 ]
Shah, Samir S. [1 ,6 ,10 ,11 ]
机构
[1] Childrens Hosp Philadelphia, Div Infect Dis, Philadelphia, PA 19104 USA
[2] Univ Penn, Sch Vet Med, Dept Microbiol, Philadelphia, PA 19104 USA
[3] Childrens Hosp Philadelphia, Div Gen Surg, Philadelphia, PA 19104 USA
[4] Univ Penn, Sch Med, Dept Surg, Philadelphia, PA 19104 USA
[5] Childrens Hosp Philadelphia, Div Neonatol, Philadelphia, PA 19104 USA
[6] Univ Penn, Sch Med, Dept Pediat, Philadelphia, PA 19104 USA
[7] Temple Univ, Dept Physiol, Philadelphia, PA 19122 USA
[8] Temple Univ, Lung Ctr, Philadelphia, PA 19122 USA
[9] Univ Penn, Sch Med, Dept Pathol & Lab Med, Philadelphia, PA 19104 USA
[10] Childrens Hosp Philadelphia, Div Gen Pediat, Philadelphia, PA 19104 USA
[11] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
关键词
empyema; molecular diagnostic techniques; pneumonia; bacterial; polymerase chain reaction; Staphylococcus aureus; Streptococcus pneumoniae; 16S RDNA PCR; PANTON-VALENTINE LEUKOCIDIN; STAPHYLOCOCCUS-AUREUS; CLINICAL MICROBIOLOGY; EMPYEMA; CHILDREN; SEPSIS; BLOOD; GENE;
D O I
10.1002/jhm.911
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: A bacterial cause is not frequently identified in children with pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia). OBJECTIVES: To determine the frequency of positive blood and pleural fluid cultures in children with complicated pneumonia and to determine whether broad-range 16S rRNA polymerase chain reaction (PCR) improves identification of a microbiologic cause. METHODS: This prospective cohort study included children 1-18 years of age hospitalized with complicated pneumonia. RESULTS: Pleural fluid drainage was performed in 64 (51.6%) of 124 children with complicated pneumonia. A microbiologic cause was identified in 11 of 64 patients (17.2%; 95% confidence interval [CI]: 8.9%-28.7%). Bacteria were isolated from pleural fluid culture in 6 of 64 patients (9.4 %; 95% CI: 3.5%-19.3%) undergoing pleural drainage; the causative bacteria were Staphylococcus aureus (n = 5) and Streptococcus pneumoniae (n 1). Blood culture identified a bacterial cause in 3 of 44 cases (6.8%; 95% CI: 1.4%-18.7%) undergoing pleural fluid drainage; S. pneumoniae (n = 1), Haemophilus influenzae (n 1), and S. aureus (n = 1) were isolated. Only 3 of the 19 pleural fluid samples (15.8%; 95% CI: 3.4%-39.6%) analyzed with 16S rRNA PCR were positive. S. pneumoniae was the only organism detected in all three samples; two of these three had negative pleural fluid cultures and absence of bacteria on Gram stain. S. aureus was isolated from pleural fluid culture in one patient with a negative 16S rRNA PCR test. CONCLUSIONS: Causative bacteria were infrequently identified in children with complicated pneumonia. Broad-range 16S rRNA PCR only modestly improved the microbiologic yield over conventional culture methods. Journal of Hospital Medicine 2012;7:8-13. (C) 2011 Society of Hospital Medicine
引用
收藏
页码:8 / 13
页数:6
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