Department of Pediatrics, University of Utah, Salt, Lake City, UT, USA.
Pediatr Infect Dis J. 2011 Apr;30(4):289-94. doi: 10.1097/INF.0b013e3182002d14.
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.
脓胸是细菌性肺炎的一种常见并发症。由于阳性培养的频率较低，因此对其进行流行病学研究很复杂。我们试图使用胸腔积液的分子分析来描述儿童脓胸的流行病学。
我们对 2009 年因脓胸住院的儿童的胸腔积液进行了细菌病原体的分子检测。采用实时聚合酶链反应（PCR）检测肺炎链球菌、金黄色葡萄球菌（包括耐甲氧西林金黄色葡萄球菌）、化脓性链球菌、流感嗜血杆菌和肺炎支原体，以及肺炎链球菌的基于 PCR 的血清分型。提取了人口统计学、实验室和微生物学数据。
63 名儿童的胸腔积液标本可用于 PCR。通过培养，在 22 名（35％）患者的血液和/或胸腔积液中分离出病原体，其中 15 名（24％）为肺炎链球菌，3 名（5％）为化脓性链球菌，4 名（6％）为耐甲氧西林金黄色葡萄球菌。通过 PCR，检测到 53 种（84％）病原体，包括 45 种（71％）肺炎链球菌。与培养相比，PCR 检测显著增加了任何病原体（35％比 84％；P <0.001）和肺炎链球菌（24％比 71％；P <0.001）的检测率。血清型 7F 是最常见的肺炎链球菌血清型。培养阴性与培养阳性疾病的比较显示，病原体谱和临床结局均存在差异。
胸腔积液的分子分析使引起脓胸的病原体的检测率增加了一倍以上。肺炎链球菌是培养阳性和培养阴性脓胸的最常见原因，尽管血清型分布和结局不同。
