Gillis Hayley D, Lang Amanda L S, ElSherif May, Martin Irene, Hatchette Todd F, McNeil Shelly A, LeBlanc Jason J
Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada.
National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada.
BMJ Open. 2017 Jun 8;7(6):e015008. doi: 10.1136/bmjopen-2016-015008.
Detection and serotyping of important to assess the impact of pneumococcal vaccines. This study describes the diagnostic accuracy of PCR-based detection of directly from nasopharyngeal (NP) swabs collected for respiratory virus studies.
Active surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed from December 2010 to 2013. Detection of pneumococcal CAP (CAP) was performed by urine antigen detection (UAD), identification of in sputum or blood cultures. was detected in NP swabs using and real-time PCR, and serotyping was performed using conventional and real-time multiplex PCRs. For serotyping, the Quellung reaction, PCR-based serotyping or a serotype-specific UAD was used.
NP swab results were compared against CAP cases where all pneumococcal tests were performed (n=434), or where at least one test was performed (n=1616). CAP was identified in 22.1% (96/434) and 14.9% (240/1616), respectively. The sensitivity of NP swab PCR for the detection of was poor for CAP (35.4% (34/96) and 34.17% (82/240)), but high specificity was observed (99.4% (336/338) and 97.89% (1347/1376)). Of the positive NP swabs, a serotype could be deduced by PCR in 88.2% (30/34) and 93.9% (77/82), respectively.
While further optimisation may be needed to increase the sensitivity of PCR-based detection, its high specificity suggests there is a value for pneumococcal surveillance. With many laboratories archiving specimens for influenza virus surveillance, this specimen type could provide a non-culture-based method for pneumococcal surveillance.
检测和血清分型对于评估肺炎球菌疫苗的影响很重要。本研究描述了基于聚合酶链反应（PCR）从为呼吸道病毒研究采集的鼻咽拭子中直接检测肺炎球菌的诊断准确性。
2010年12月至2013年对住院成人社区获得性肺炎（CAP）进行主动监测。通过尿抗原检测（UAD）、痰液或血培养中肺炎球菌的鉴定来检测肺炎球菌性CAP。使用常规PCR和实时PCR在鼻咽拭子中检测肺炎球菌，并使用常规和实时多重PCR进行血清分型。对于血清分型，采用荚膜肿胀反应、基于PCR的血清分型或血清型特异性尿抗原检测。
将鼻咽拭子结果与所有肺炎球菌检测均进行的CAP病例（n = 434）或至少进行一项检测的CAP病例（n = 1616）进行比较。分别在22.1%（96/434）和14.9%（240/1616）的病例中鉴定出CAP。对于CAP，鼻咽拭子PCR检测肺炎球菌的敏感性较差（35.4%（34/96）和34.17%（82/240）），但观察到高特异性（99.4%（336/338）和97.89%（1347/1376））。在阳性鼻咽拭子中，分别有88.2%（30/34）和93.9%（77/82）可通过PCR推断出血清型。
虽然可能需要进一步优化以提高基于PCR检测的敏感性，但其高特异性表明肺炎球菌监测具有价值。由于许多实验室为流感病毒监测存档标本，这种标本类型可为肺炎球菌监测提供一种非培养方法。
