BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: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. METHODS: 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. RESULTS: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. CONCLUSIONS: 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.
Authors: Carrie L Byington; LaShonda Y Spencer; Timothy A Johnson; Andrew T Pavia; Daniel Allen; Edward O Mason; Sheldon Kaplan; Karen C Carroll; Judy A Daly; John C Christenson; Matthew H Samore Journal: Clin Infect Dis Date: 2002-01-03 Impact factor: 9.079
Authors: Krow Ampofo; Amy Herbener; Anne J Blaschke; Caroline Heyrend; Mark Poritz; Kent Korgenski; Robert Rolfs; Seema Jain; Maria da Glória Carvalho; Fabiana C Pimenta; Judy Daly; Edward O Mason; Carrie L Byington; Andrew T Pavia Journal: Pediatr Infect Dis J Date: 2010-10 Impact factor: 2.129
Authors: Karen D Schultz; Leland L Fan; Jay Pinsky; Lyssa Ochoa; E O'Brian Smith; Sheldon L Kaplan; Mary L Brandt Journal: Pediatrics Date: 2004-06 Impact factor: 7.124
Authors: Chris Stockmann; Krow Ampofo; Adam L Hersh; Anne J Blaschke; Brian A Kendall; Kent Korgenski; Judy Daly; Harry R Hill; Carrie L Byington; Andrew T Pavia Journal: Clin Infect Dis Date: 2012-04-24 Impact factor: 9.079
Authors: John S Bradley; Carrie L Byington; Samir S Shah; Brian Alverson; Edward R Carter; Christopher Harrison; Sheldon L Kaplan; Sharon E Mace; George H McCracken; Matthew R Moore; Shawn D St Peter; Jana A Stockwell; Jack T Swanson Journal: Clin Infect Dis Date: 2011-08-31 Impact factor: 9.079
Authors: Seema Jain; Wesley H Self; Richard G Wunderink; Sherene Fakhran; Robert Balk; Anna M Bramley; Carrie Reed; Carlos G Grijalva; Evan J Anderson; D Mark Courtney; James D Chappell; Chao Qi; Eric M Hart; Frank Carroll; Christopher Trabue; Helen K Donnelly; Derek J Williams; Yuwei Zhu; Sandra R Arnold; Krow Ampofo; Grant W Waterer; Min Levine; Stephen Lindstrom; Jonas M Winchell; Jacqueline M Katz; Dean Erdman; Eileen Schneider; Lauri A Hicks; Jonathan A McCullers; Andrew T Pavia; Kathryn M Edwards; Lyn Finelli Journal: N Engl J Med Date: 2015-07-14 Impact factor: 91.245
Authors: Fabiana C Pimenta; Alexis Roundtree; Ahmet Soysal; Mustafa Bakir; Mignon du Plessis; Nicole Wolter; Anne von Gottberg; Lesley McGee; Maria da Gloria Carvalho; Bernard Beall Journal: J Clin Microbiol Date: 2012-12-05 Impact factor: 5.948