Molecular Analysis Improves Pathogen Identification and Epidemiologic Study of Pediatric Parapneumonic Empyema

Details

• Alternative Title:
  Pediatr Infect Dis J
• Personal Author:
  Blaschke, Anne J. ; Heyrend, Caroline ; Byington, Carrie L. ; Obando, Ignacio ; Vazquez-Barba, Isabel ; Doby, Elizabeth H. ; Korgenski, E. Kent ; Sheng, Xiaoming ; Poritz, Mark A. ; Daly, Judy A. ; Mason, Edward O. ; Pavia, Andrew T. ; Ampofo, Krow
• Description:
  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.|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.|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.|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.
• Subjects:
  Adolescent Bacterial Infections Bacteriological Techniques Child Child, Preschool Empyema, Pleural Female Haemophilus Influenzae Humans Infant Male Molecular Diagnostic Techniques Mycoplasma Pneumoniae Prevalence Staphylococcus Aureus Streptococcus Pyogenes

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• Source:
  Pediatr Infect Dis J. 30(4):289-294.
• Pubmed ID:
  21057372
• Pubmed Central ID:
  PMC3053443
• Document Type:
  Journal Article
• Funding:
  1K23AI079401/AI/NIAID NIH HHS/United States ; 1R01 AI089489-01/AI/NIAID NIH HHS/United States ; 1U01AI082184-01/AI/NIAID NIH HHS/United States ; 1U18IP000303-01/IP/NCIRD CDC HHS/United States ; K-24 HD047249-01/HD/NICHD NIH HHS/United States ; K23 AI079401/AI/NIAID NIH HHS/United States ; K23 AI079401-02/AI/NIAID NIH HHS/United States ; K24 HD047249/HD/NICHD NIH HHS/United States ; K24 HD047249-04/HD/NICHD NIH HHS/United States ; R01 AI089489-01/AI/NIAID NIH HHS/United States ; U01 AI082184-01/AI/NIAID NIH HHS/United States
• Volume:
  30
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:db8603f1307a15d759a406e9784a8026bcf4eaa99d520a464b780a582ed7b9ac
• Download URL:
  https://stacks.cdc.gov/view/cdc/33184/cdc_33184_DS1.pdf
• File Type:
  [PDF - 296.24 KB ]