Gollomp Kandace, Rankin Shelley C, White Caitlin, Mattei Peter, Harris Mary C, Kilpatrick Laurie E, Sheffler-Collins Seth, McGowan Karin L, Shah Samir S
Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Hosp Med. 2012 Jan;7(1):8-13. doi: 10.1002/jhm.911. Epub 2011 Oct 12.
A bacterial cause is not frequently identified in children with pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia).
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.
This prospective cohort study included children 1-18 years of age hospitalized with complicated pneumonia.
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.
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.
肺炎合并胸腔积液（即复杂性肺炎）患儿中，细菌病因并不常见。
确定复杂性肺炎患儿血培养和胸腔积液培养阳性的频率，并确定广谱16S rRNA聚合酶链反应（PCR）是否能提高微生物病因的识别率。
这项前瞻性队列研究纳入了1至18岁因复杂性肺炎住院的儿童。
124例复杂性肺炎患儿中，64例（51.6%）进行了胸腔积液引流。64例患者中有11例（17.2%；95%置信区间[CI]：8.9%-28.7%）确定了微生物病因。在64例接受胸腔引流的患者中，6例（9.4%；95%CI：3.5%-19.3%）胸腔积液培养分离出细菌；致病菌为金黄色葡萄球菌（n = 5）和肺炎链球菌（n = 1）。44例接受胸腔积液引流的病例中，3例（6.8%；95%CI：1.4%-18.7%）血培养确定了细菌病因；分离出肺炎链球菌（n = 1）、流感嗜血杆菌（n = 1）和金黄色葡萄球菌（n = 1）。19份胸腔积液样本中，仅3份（15.8%；95%CI：3.4%-39.6%）经16S rRNA PCR分析呈阳性。所有三份样本中检测到的唯一病原体均为肺炎链球菌；这三份样本中有两份胸腔积液培养阴性且革兰氏染色未见细菌。1例16S rRNA PCR检测阴性的患者胸腔积液培养分离出金黄色葡萄球菌。
复杂性肺炎患儿中，致病菌并不常见。与传统培养方法相比，广谱16S rRNA PCR仅适度提高了微生物检出率。
