Broad-range bacterial polymerase chain reaction in the microbiologic diagnosis of complicated pneumonia
- Resource Type
- Academic Journal
- Authors
- Gollomp, Kandace; Rankin, Shelley C.; White, Caitlin; Mattei, Peter; Harris, Mary C.; Kilpatrick, Laurie E.; Sheffler-Collins, Seth; McGowan, Karin L.; Shah, Samir S.
- Source
- Journal Of Hospital Medicine. Jan 01, 2012 7(1):8-13
- Subject
- Language
- English
- ISSN
- 1553-5606
BACKGROUND:: A bacterial cause is not frequently identified in children with pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia). OBJECTIVES:: To determine the frequency of positive blood and pleural fluid cultures in children with complicated pneumonia and to determine whether broad-range 16S rRNA polymerase chain reaction (PCR) improves identification of a microbiologic cause. METHODS:: This prospective cohort study included children 1–18 years of age hospitalized with complicated pneumonia. RESULTS:: Pleural fluid drainage was performed in 64 (51.6%) of 124 children with complicated pneumonia. A microbiologic cause was identified in 11 of 64 patients (17.2%; 95% confidence interval [CI]: 8.9%–28.7%). Bacteria were isolated from pleural fluid culture in 6 of 64 patients (9.4 %; 95% CI: 3.5%–19.3%) undergoing pleural drainage; the causative bacteria were Staphylococcus aureus (n = 5) and Streptococcus pneumoniae (n = 1). Blood culture identified a bacterial cause in 3 of 44 cases (6.8%; 95% CI: 1.4%–18.7%) undergoing pleural fluid drainage; S. pneumoniae (n = 1), Haemophilus influenzae (n = 1), and S. aureus (n = 1) were isolated. Only 3 of the 19 pleural fluid samples (15.8%; 95% CI: 3.4%–39.6%) analyzed with 16S rRNA PCR were positive. S. pneumoniae was the only organism detected in all three samples; two of these three had negative pleural fluid cultures and absence of bacteria on Gram stain. S. aureus was isolated from pleural fluid culture in one patient with a negative 16S rRNA PCR test. CONCLUSIONS:: Causative bacteria were infrequently identified in children with complicated pneumonia. Broad-range 16S rRNA PCR only modestly improved the microbiologic yield over conventional culture methods. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine