Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

被引:47
作者
Sauteur, Patrick M. Meyer [1 ]
Krautter, Selina [1 ]
Ambroggio, Lilliam [2 ]
Seiler, Michelle [3 ]
Paioni, Paolo [1 ]
Relly, Christa [1 ]
Capaul, Riccarda [4 ]
Kellenberger, Christian [5 ]
Haas, Thorsten [6 ]
Gysin, Claudine [7 ]
Bachmann, Lucas M. [8 ]
van Rossum, Annemarie M. C. [9 ]
Berger, Christoph [1 ]
机构
[1] Univ Childrens Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Steinwiesstr 75, CH-8032 Zurich, Switzerland
[2] Emergency Med & Hosp Med, Childrens Hosp Colorado, Denver, CO USA
[3] Univ Childrens Hosp Zurich, Emergency Dept, Zurich, Switzerland
[4] Univ Zurich, Inst Med Virol, Zurich, Switzerland
[5] Univ Childrens Hosp Zurich, Div Diagnost Imaging, Zurich, Switzerland
[6] Univ Childrens Hosp Zurich, Div Anesthesiol, Zurich, Switzerland
[7] Univ Childrens Hosp Zurich, Div Otolaryngol, Zurich, Switzerland
[8] Medignit Inc Res Consultants, Zurich, Switzerland
[9] Erasmus MC Univ Med Ctr, Dept Pediat, Div Pediat Infect Dis & Immunol, Sophia Childrens Hosp, Rotterdam, Netherlands
关键词
antibiotics; C-reactive protein; diagnosis; procalcitonin; treatment; STANDARDIZED INTERPRETATION; PEDIATRIC PNEUMONIA; CHEST RADIOGRAPHS; INFECTION; PROCALCITONIN; TRANSMISSION; OUTBREAK; VIRUSES;
D O I
10.1093/cid/ciz1059
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. There are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in community-acquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific immunoglobulin M antibody-secreting cells (ASCs) by enzyme-linked immunospot assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection. Methods. This is a prospective cohort study of children, 3-18 years of age, with CAP from 2016 to 2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher exact test, as appropriate. Area under the receiver operating characteristic curve (AUC) differences and optimal thresholds were determined by using the DeLong test and Youden J statistic, respectively. Results. Of 63 CAP patients, 29 were Mp-positive (46%). Mp positivity was statistically associated with older age (median, 8.6 vs 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT <0.25 mu g/L, were statistically associated with Mp infection. A combination of age >5 years (AUC = 0.77), prodromal fever and respiratory symptoms >6 days (AUC = 0.79), and PCT <0.25 mu g/L (AUC = 0.81) improved diagnostic performance (AUC = 0.90) (P = .05). Conclusions. A combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.
引用
收藏
页码:1645 / 1654
页数:10
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