Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema.
Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema.
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分子分析改善了病原体鉴定和小儿parapneumonic富裕症的流行病学研究。
DOI：
10.1097/inf.0b013e3182002d14
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发表时间：
2011-04
期刊：
影响因子：
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通讯作者：
Ampofo K
中科院分区：
文献类型：
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作者：
Blaschke AJ;Heyrend C;Byington CL;Obando I;Vazquez-Barba I;Doby EH;Korgenski EK;Sheng X;Poritz MA;Daly JA;Mason EO;Pavia AT;Ampofo K
背景：胸膜旁脓胸（PPE）是细菌性肺炎越来越常见的并发症。流行病学研究由于阳性培养物的低频率而变得复杂。我们试图描述PPE在儿童使用分子分析pleasure fluid.Methods的流行病学：我们进行了细菌病原体的分子检测，使用存档的胸腔积液从2009年住院的儿童与PPE。实时聚合酶链反应（PCR）检测肺炎链球菌、金黄色葡萄球菌（包括耐甲氧西林）、化脓性链球菌、流感嗜血杆菌和肺炎支原体，以及基于PCR的S. pneumoniae进行。人口统计学，实验室，和微生物学数据abstracted.Results：从63名儿童的胸腔积液标本可用于PCR。通过培养，22例（35%）患者的血液和/或胸腔积液中分离到病原体，其中S。肺炎链球菌15株（24%）;化脓性葡萄球菌3株（5%），耐甲氧西林金黄色葡萄球菌4株（6%）。PCR检测53例（84%）检出病原体，包括沙门氏菌。肺炎45例（71%）。与培养相比，PCR检测显著增加了任何病原体的检出率（35%对84%; P< 0.001）和S。肺炎链球菌感染（24% vs.71%; P< 0.001）。血清型7 F是最常见的肺炎球菌血清型检测。比较培养阴性培养阳性疾病的病原体概况和临床outcomes.Conclusions的差异：胸膜液的分子分析增加了一倍以上的病原体引起PPE的检测。S.肺炎是培养阳性和培养阴性PPE的最常见原因，尽管血清型分布和结果不同。
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.