NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cell Infect Microbiol. 2021 Jul 21;11:695134. doi: 10.3389/fcimb.2021.695134. eCollection 2021.
The objective of this study was to evaluate the value of molecular methods in the management of community-acquired pneumonia (CAP) in children. Previously developed mass spectrometry (MS)-based methods combined with quantitative real-time PCR (combined-MS methods) were used to describe the aetiology and evaluate antibiotic therapy in the enrolled children. Sputum collected from 302 children hospitalized with CAP were analyzed using the combined-MS methods, which can detect 19 viruses and 12 bacteria related to CAP. Based on the results, appropriate antibiotics were determined using national guidelines and compared with the initial empirical therapies. Respiratory pathogens were identified in 84.4% of the patients (255/302). Co-infection was the predominant infection pattern (51.7%, 156/302) and was primarily a bacterial-viral mixed infection (36.8%, 111/302). Compared with that using culture-based methods, the identification rate for bacteria using the combined-MS methods (61.8%, 126/204) increased by 28.5% (0.001). Based on the results of the combined-MS methods, the initial antibiotic treatment of 235 patients was not optimal, which mostly required switching to β-lactam/β-lactamase inhibitor combinations or reducing unnecessary macrolide treatments. Moreover, using the combined-MS methods to guide antibiotic therapy showed potential to decrease the length of stay in children with severe CAP. For children with CAP, quantitative molecular testing on sputum can serve as an important complement to traditional culture methods. Early aetiology elucidated using molecular testing can help guide the antibiotic therapy.
本研究旨在评估分子方法在儿童社区获得性肺炎（CAP）管理中的价值。先前开发的基于质谱（MS）的方法与定量实时 PCR（组合-MS 方法）相结合，用于描述病因，并评估纳入儿童的抗生素治疗效果。采用组合-MS 方法分析了 302 例因 CAP 住院的儿童的痰液，该方法可检测与 CAP 相关的 19 种病毒和 12 种细菌。根据结果，使用国家指南确定适当的抗生素，并与初始经验性治疗进行比较。在 84.4%的患者（255/302）中确定了呼吸道病原体。混合感染是主要的感染模式（51.7%，156/302），主要是细菌-病毒混合感染（36.8%，111/302）。与基于培养的方法相比，组合-MS 方法对细菌的鉴定率（61.8%，126/204）提高了 28.5%（0.001）。根据组合-MS 方法的结果，235 名患者的初始抗生素治疗并不理想，主要需要更换β-内酰胺/β-内酰胺酶抑制剂联合用药或减少不必要的大环内酯类药物治疗。此外，使用组合-MS 方法指导抗生素治疗可能有助于减少重症 CAP 患儿的住院时间。对于 CAP 患儿，痰液的定量分子检测可以作为传统培养方法的重要补充。早期使用分子检测确定病因有助于指导抗生素治疗。
