Pediatric Critical Care Unit, Servicio de Críticos, Intermedios y Urgencias Pediátricas, Area de Pediatria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
J Crit Care. 2012 Jun;27(3):321.e1-4. doi: 10.1016/j.jcrc.2011.05.004. Epub 2011 Jul 6.
The purpose of the study was to assess the diagnostic value of rapid pneumococcal antigen detection (PAD) in pleural fluid samples of children with empyema.
We performed a prospective evaluation in a pediatric intensive care unit of a tertiary university hospital of children aged 1 month to 14 years admitted with empyema. Standard cultures (conventional microbiological culture [CMC]), PAD by immunochromatographic testing (Binax NOW Streptococcus pneumoniae; Binax, Portland, ME), and/or real-time polymerase chain reactions (RTPs) on pleural samples were performed in all included patients.
Fifty-five cases with a mean (SD) age of 6.5 (6.1) years were enrolled. Streptococcus pneumoniae was identified in 28 cases (51%): by CMC in 15 cases and by RTP in a further 13 cases. Using CMC and/or RTP as the criterion standard, PAD showed a sensitivity of 96% (95% confidence interval, 86%-100%), a specificity of 100% (75%-100%), a positive predictive value of 100% (98%-100%), and a Youden index of 0.96 (0.88-1.04).
Pneumococcal antigen detection in pleural fluid specimens from children provides a rapid, simple, sensitive, and reliable method of diagnosis for pneumococcal empyema at bedside.
本研究旨在评估快速肺炎球菌抗原检测（PAD）在脓胸患儿胸腔积液样本中的诊断价值。
我们在一所三级大学医院的儿科重症监护病房进行了一项前瞻性评估，纳入了年龄在 1 个月至 14 岁之间因脓胸入院的儿童。对所有纳入的患者均进行标准培养（常规微生物培养[CMC]）、免疫层析检测的 PAD（Binax NOW 肺炎链球菌；Binax，波特兰，ME）和/或胸腔样本的实时聚合酶链反应（RTP）。
共纳入 55 例，平均（SD）年龄为 6.5（6.1）岁。28 例（51%）鉴定出肺炎链球菌：15 例通过 CMC 鉴定，13 例通过 RTP 鉴定。以 CMC 和/或 RTP 为标准，PAD 的敏感性为 96%（95%置信区间，86%-100%），特异性为 100%（75%-100%），阳性预测值为 100%（98%-100%），Youden 指数为 0.96（0.88-1.04）。
儿童胸腔积液标本中肺炎球菌抗原检测可提供一种快速、简便、敏感、可靠的床边诊断方法，适用于肺炎球菌性脓胸。
