TY - JOUR
T1 - Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema
AU - Blaschke, Anne J.
AU - Heyrend, Caroline
AU - Byington, Carrie L.
AU - Obando, Ignacio
AU - Vazquez-Barba, Isabel
AU - Doby, Elizabeth H.
AU - Korgenski, E. Kent
AU - Sheng, Xiaoming
AU - Poritz, Mark A.
AU - Daly, Judy A.
AU - Mason, Edward O.
AU - Pavia, Andrew T.
AU - Ampofo, Krow
PY - 2011/4
Y1 - 2011/4
N2 - Background: Parapneumonic empyema (PPE) is an increasingly common complication of bacterial pneumonia. Epidemiologic study is complicated by the low frequency of positive cultures. We sought to describe the epidemiology of PPE in children using molecular analysis of pleural fluid. Methods: We performed molecular testing for bacterial pathogens using archived pleural fluid from children hospitalized in 2009 with PPE. Real-time polymerase chain reaction (PCR) to detect Streptococcus pneumoniae, Staphylococcus aureus (including methicillin-resistant), Streptococcus pyogenes, Haemophilus influenzae, and Mycoplasma pneumoniae as well as PCR-based serotyping of S. pneumoniae was performed. Demographic, laboratory, and microbiologic data were abstracted. Results: Pleural fluid specimens from 63 children were available for PCR. By culture, a pathogen was isolated from blood and/or pleural fluid in 22 (35%) patients, with S. pneumoniae in 15 (24%), S. pyogenes in 3 (5%), and methicillin-resistant Staphylococcus aureus in 4 (6%). By PCR, a pathogen was detected in 53 (84%), including S. pneumoniae in 45 (71%). Compared with culture, PCR testing significantly increased detection of any pathogen (35% vs. 84%; P < 0.001) and of S. pneumoniae (24% vs. 71%; P < 0.001). Serotype 7F was the most common pneumococcal serotype detected. Comparison of culture-negative to culture-positive disease showed differences in both the pathogen profile and clinical outcomes. Conclusions: Molecular analysis of pleural fluid more than doubled the detection of pathogens causing PPE. S. pneumoniae was the most common cause of both culture-positive and culture-negative PPE, although serotype distribution and outcomes differed.
AB - Background: Parapneumonic empyema (PPE) is an increasingly common complication of bacterial pneumonia. Epidemiologic study is complicated by the low frequency of positive cultures. We sought to describe the epidemiology of PPE in children using molecular analysis of pleural fluid. Methods: We performed molecular testing for bacterial pathogens using archived pleural fluid from children hospitalized in 2009 with PPE. Real-time polymerase chain reaction (PCR) to detect Streptococcus pneumoniae, Staphylococcus aureus (including methicillin-resistant), Streptococcus pyogenes, Haemophilus influenzae, and Mycoplasma pneumoniae as well as PCR-based serotyping of S. pneumoniae was performed. Demographic, laboratory, and microbiologic data were abstracted. Results: Pleural fluid specimens from 63 children were available for PCR. By culture, a pathogen was isolated from blood and/or pleural fluid in 22 (35%) patients, with S. pneumoniae in 15 (24%), S. pyogenes in 3 (5%), and methicillin-resistant Staphylococcus aureus in 4 (6%). By PCR, a pathogen was detected in 53 (84%), including S. pneumoniae in 45 (71%). Compared with culture, PCR testing significantly increased detection of any pathogen (35% vs. 84%; P < 0.001) and of S. pneumoniae (24% vs. 71%; P < 0.001). Serotype 7F was the most common pneumococcal serotype detected. Comparison of culture-negative to culture-positive disease showed differences in both the pathogen profile and clinical outcomes. Conclusions: Molecular analysis of pleural fluid more than doubled the detection of pathogens causing PPE. S. pneumoniae was the most common cause of both culture-positive and culture-negative PPE, although serotype distribution and outcomes differed.
KW - Bacterial complications
KW - Epidemiology
KW - Molecular diagnostics
KW - Pneumococcal empyema
KW - Pneumonia
KW - Polymerase chain reaction (PCR)
KW - Streptococcus pneumoniae
UR - http://www.scopus.com/inward/record.url?scp=79954972071&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79954972071&partnerID=8YFLogxK
U2 - 10.1097/INF.0b013e3182002d14
DO - 10.1097/INF.0b013e3182002d14
M3 - Article
C2 - 21057372
AN - SCOPUS:79954972071
VL - 30
SP - 289
EP - 294
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
SN - 0891-3668
IS - 4
ER -