Pneumococcal Colonization Rates in Patients Admitted to a United Kingdom Hospital with Lower Respiratory Tract Infection: a Prospective Case-Control Study.
Pneumococcal Colonization Rates in Patients Admitted to a United Kingdom Hospital with Lower Respiratory Tract Infection: a Prospective Case-Control Study.
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DOI：
10.1128/jcm.02008-15
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发表时间：
2016-04
影响因子：
9.4
通讯作者：
Gordon SB
中科院分区：
文献类型：
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作者：
Collins AM;Johnstone CM;Gritzfeld JF;Banyard A;Hancock CA;Wright AD;Macfarlane L;Ferreira DM;Gordon SB
目前的诊断测试是无效的，以确定下呼吸道感染（LRTI）住院成人的病原体。肺炎球菌定植与疾病的关联已被认为是提高诊断准确性的一种手段。我们通过（i）经典培养和（ii）靶向lytA的定量实时PCR（qPCR）比较了英国一家医院收治的LRTI患者和对照患者的肺炎球菌定植率和鼻肺炎球菌定植密度。共筛选了826例患者纳入本前瞻性病例对照研究。其中，招募了38例患者，19例确诊为LRTI，19例为其他诊断的对照组。在招募时采集鼻洗液（NW）样本。经典培养法在1例下呼吸道感染患者和3例对照组中检出肺炎球菌定植（P = 0.6）。通过qPCR，在10例LRTI患者和8例对照中检测到肺炎球菌定植（P = 0.5）。下呼吸道感染组采样前抗生素使用率显著高于对照组（19比3; P < 0.001）。在qPCR的临床相关临界值> 8，000拷贝/ml时，在3例LRTI患者和4例对照中发现肺炎球菌定植（P > 0.05）。我们的结论是，无论是患病率还是密度的鼻肺炎球菌定植（通过文化和qPCR）可以作为一种方法，在英国的LRTI住院成人的微生物诊断。在抗生素治疗前招募患者进行以社区为基础的研究可能是未来有用的一步。
Current diagnostic tests are ineffective for identifying the etiological pathogen in hospitalized adults with lower respiratory tract infections (LRTIs). The association of pneumococcal colonization with disease has been suggested as a means to increase the diagnostic precision. We compared the pneumococcal colonization rates and the densities of nasal pneumococcal colonization by (i) classical culture and (ii) quantitative real-time PCR (qPCR) targeting lytA in patients with LRTIs admitted to a hospital in the United Kingdom and control patients. A total of 826 patients were screened for inclusion in this prospective case-control study. Of these, 38 patients were recruited, 19 with confirmed LRTIs and 19 controls with other diagnoses. Nasal wash (NW) samples were collected at the time of recruitment. Pneumococcal colonization was detected in 1 patient with LRTI and 3 controls (P = 0.6) by classical culture. By qPCR, pneumococcal colonization was detected in 10 LRTI patients and 8 controls (P = 0.5). Antibiotic usage prior to sampling was significantly higher in the LRTI group than in the control group (19 versus 3; P < 0.001). With a clinically relevant cutoff of >8,000 copies/ml on qPCR, pneumococcal colonization was found in 3 LRTI patients and 4 controls (P > 0.05). We conclude that neither the prevalence nor the density of nasal pneumococcal colonization (by culture and qPCR) can be used as a method of microbiological diagnosis in hospitalized adults with LRTI in the United Kingdom. A community-based study recruiting patients prior to antibiotic therapy may be a useful future step.