169. Molecular Evaluation and Pathogen Identification from Pleural Fluid in Pediatric Parapneumonic Empyema: Preliminary Data from the CDC Etiology of Pneumonia in the Community (EPIC) Study
Session: Oral Abstract Session: Pediatric Pneumonia
Friday, October 21, 2011: 11:15 AM
Room: 156ABC
Background:   

We investigated the etiology of pediatric parapneumonic empyema (PPE) in U.S. children and compared microbiologic results derived by real-time polymerase-chain-reaction (PCR) with culture methods.

Methods: 

Children <18 years hospitalized with clinical and radiographic pneumonia were enrolled in an ongoing CDC pneumonia etiology study. Blood for cultures and pneumococcal PCR, and naso/oropharyngeal samples for PCR for respiratory viruses and atypical bacteria were obtained from all patients.  Patients who underwent therapeutic thoracentesis had pleural fluid (PF) bacterial culture and PCR performed to detect Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, Myocoplasma pneumoniae, Streptococcus spp., and Fusobacterium spp. PCR for 10 respiratory viruses was also performed. 

Results: 

From 1/2010-2/2011, we obtained PF samples from 33 children hospitalized with PPE at 3 study sites (Utah-29, Vanderbilt-2, Memphis-2). PF PCR testing increased pathogen identification over culture alone from 15 (45%) to 24 (73%) (P=0.03). There was 93% concordance between culture-positive and PCR-positive PF. S. pyogenes was the most common pathogen detected by culture (33%) and PCR (36%), followed by S. pneumoniae (6% by culture; 33% by PCR). Streptococcus spp. (6%) and H. influenzae (3%) were detected by both culture and PCR and Fusobacterium spp. (3%) by PCR alone. A bacterial pathogen was detected by PCR in 10 (55%) of 18 culture-negative PF specimens. S. pneumoniae (44%) was the most common cause of culture-negative PPE.  Thirteen (39%) children received antibiotics before thoracentesis; PCR identified a pathogen in culture-negative PF in 8 (61%) of 13 pre-treated children and 16 (80%) of 20 who were not pre-treated. Multiple bacteria were detected in PF by culture in 1 (3%) and by PCR in 3 (9%). Respiratory syncytial virus was also detected in 2 (6%) PF samples by PCR, which were concordant with upper respiratory sample results.   

Conclusion: 

S. pyogenes was the most common cause of culture-positive PPE, and S. pneumoniae was the most frequent cause of culture-negative PPE. PF PCR testing significantly improved bacterial detection and should be considered for clinical care and antimicrobial selection.


Subject Category: P. Pediatric and perinatal infections

Krow Ampofo, MD1, Chris Stockmann, BS2, Anne Blaschke, MD, PhD1, Carrie L. Byington, MD1, Caroline Heyrend, BS3, Derek J. Williams, MD, MPH4, Kathryn Edwards, MD, FIDSA5, Sandra R. Arnold, MD6, Jonathan A. McCullers, MD7, Lauri Hicks, DO8, Maria da Gloria Carvalho, PhD8, Seema Jain, MD8 and Andrew Pavia, MD, FIDSA1, (1)University of Utah, Salt Lake City, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)Idaho Technology, Inc., Salt Lake City, UT, (4)Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, (5)Div of ID, Vanderbilt University Medical Center, Nashville, TN, (6)Le Bonheur Children's Hospital, Memphis, TN, (7)St. Jude Children's Research Hospital, Memphis, TN, (8)Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

K. Ampofo, None

C. Stockmann, None

A. Blaschke, Idaho Technology, Inc.: Collaborator, Research support

C. L. Byington, Idaho Technology, Inc.: Grant Investigator, Research grant and intellectual property rights

C. Heyrend, Idaho Technology Inc.: Employee, Salary

D. J. Williams, None

K. Edwards, None

S. R. Arnold, None

J. A. McCullers, AVIBioPharma: Consultant, Consulting fee
GlaxoSmithKline: Consultant, Consulting fee
Novartis: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee

L. Hicks, None

M. D. G. Carvalho, None

S. Jain, None

A. Pavia, None

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