Diagnosis of Streptococcus pneumoniae lower respiratory infection in hospitalized children by culture, polymerase chain reaction, serological testing, and urinary antigen detection
Diagnosis of Streptococcus pneumoniae lower respiratory infection in hospitalized children by culture, polymerase chain reaction, serological testing, and urinary antigen detection
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DOI：
10.1086/324358
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发表时间：
2002-01-01
影响因子：
11.8
通讯作者：
McCracken, GH
中科院分区：
文献类型：
--
作者：
Michelow, IC;Lozano, J;McCracken, GH
对 154 名患有下呼吸道感染的连续高危住院儿童进行了一项前瞻性研究，以确定基于肺炎链球菌溶血素的聚合酶链反应 (PCR) 检测与血液和胸水培养以及血清学和尿抗原检测相比的临床效用，以确定肺炎链球菌的发病率。 67 名儿童 (44%) 的全血、血沉棕黄层或血浆样本经 PCR 检测呈阳性。 11 名立即接受检测并经培养证实的儿童的敏感性为 100%，对照受试者的特异性为 95%。年龄、既往口服抗生素治疗和肺炎球菌鼻咽定植并不影响 PCR 结果，而疾病严重程度的几个替代指标与阳性检测相关。尽管血清学和尿抗原检测具有相当的敏感性，但受感染儿童的特异性不同，并且所有检测之间的统计一致性有限。这些发现支持使用 PCR 检测来评估肺炎球菌结合疫苗的保护功效，并及时识别患有经过治疗或非菌血症性肺炎球菌下呼吸道感染的儿童。
A prospective study of 154 consecutive high-risk hospitalized children with lower respiratory infections was conducted to determine the clinical utility of a pneumolysin-based polymerase chain reaction (PCR) assay compared with blood and pleural fluid cultures and serological and urinary antigen tests to determine the incidence of Streptococcus pneumoniae. Whole blood, buffy coat, or plasma samples from 67 children (44%) tested positive by PCR. Sensitivity was 100% among 11 promptly tested culture-confirmed children and specificity was 95% among control subjects. Age, prior oral antibiotic therapy, and pneumococcal nasopharyngeal colonization did not influence PCR results, whereas several surrogates of disease severity were associated with positive tests. Although serological and urinary antigen tests had comparable sensitivity, specificity varied among infected children, and statistical agreement among all assays was limited. These findings support the use of PCR tests to evaluate the protective efficacy of pneumococcal conjugate vaccines and to identify promptly children with pretreated or nonbacteremic pneumococcal lower respiratory infections.