917. Polymerase Chain Reaction (PCR) Improves Pathogen Identification from Pleural Fluid of Children and Adults hospitalized with Community Acquired Pneumonia (CAP): Preliminary Results from the Etiology of Pneumonia in the Community (EPIC) Study
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA Poster (PPE) -- 30September2013.pdf (1.0 MB)
  • Background: When patients with pneumonia complicated by parapneumonic effusion (PPE) are culture-negative, physicians struggle to identify the most effective therapy.  Our objective was to determine whether PCR testing of pleural fluid (PF) increases the diagnostic yield of PPE.

    Methods: From 1/2010-6/2012, children (<18 years) and adults hospitalized with clinical and radiographic CAP in 4 study sites were prospectively enrolled in the CDC EPIC study.  Blood and PF from patients who underwent thoracentesis were tested by culture and real time PCR for selected viral and bacterial agents.

    Results: PF samples were obtained from 63/2257 (3%) children and 34/2210 (1.5%) adults. Overall, PF PCR testing increased bacterial identification from 36% to 62% when compared to blood and PF culture (P<0.001). PF PCR testing increased bacterial identification over PF culture alone from 28 (29%) to 57 (59%) (P<0.001) overall; from 41% to 79% (P<0.001) in children and 6% to 21% (P=0.04) in adults (Table).  Seven (11%) PF samples were also positive for respiratory viruses by PCR, including: respiratory syncytial virus (n=4), human metapneumovirus (n=2), and coronavirus (n=1).

     

    Bacterial

    Pathogens

    Children (n = 63)

    Adults (n = 34)

    PF Culture Positive

    Blood and/or PF Culture Positive

    PF

    PCR Positive

    PF Culture Positive

    Blood and/or PF Culture Positive

    PF

    PCR Positive

    S. pneumoniae

    7 (11%)

    7 (11%)

    24 (38%)

    0

    0

    1 (3%)

    S. pyogenes

    11 (17%)

    14 (22%)

    16 (25%)

    0

    0

    0

    MRSA

    6 (10%)

    6 (10%)

    7 (11%)

    1 (3%)

    1 (3%)

    1 (3%)

    MSSA

    0

    0

    2 (3%)

    0

    0

    0

    H. influenzae

    1 (2%)

    1 (2%)

    2 (3%)

    0

    0

    1 (3%)

    Streptococcus spp.

    2 (3%)

    2 (3%)

    2 (3%)

    0

    0

    0

    Others1

    0

    0

    3 (5%)

    1 (3%)

    5 (15%)

    5 (15%)

    Any bacterial positive 2

    26 (41%)

    29 (46%)

    50 (79%)

    2 (6%)

    6 (18%)

    7 (21%)

    Bacterial-bacterial co-detection

    1 (2%)

    1 (2%)

    4 (6%)

    0

    0

    1 (3%)

    Bacterial-viral co-detection

    NA

    NA

    7 (11%)

    NA

    NA

    0

    1 Others include Fusobacterium spp., M. pneumoniae,  E. coli, P. aeruginosa, K. oxytoca, Enterococci, and other Enterobacteriaceae

    2 Sums to less than the total above due to co-detections

    Conclusion: PF PCR testing significantly improves bacterial identification and also detects viruses, which can help inform antimicrobial selection. PF PCR yields were lower in adults perhaps because of effusions caused by etiologies not targeted by our assays, including non-infectious causes.

    Krow Ampofo, MD1, Chris Stockmann, MSc2, Anne Blaschke, MD, PhD2, Maria Da Gloria Carvalho, PhD3, Anna M. Bramley, MPH3, Derek J. Williams, MD, MPH4, Wesley H. Self, MD, MPH4, Kathryn Edwards, MD, FIDSA4, Carlos G. Grijalva, MD, MPH4, Yuwei Zhu, MD, MS4, Evan J. Anderson, MD5, Richard G. Wunderink, MD5, Mark Courtney, MD5, Chao Qi, PhD5, Sandra Arnold, MD6, Jonathan A. Mccullers, MD7, Lauri Hicks, DO3, Dean Erdman, Dr PH3, Adam L. Hersh, MD, PhD2, Carrie L. Byington, MD2, Seema Jain, MD3 and Andrew Pavia, MD, FIDSA, FSHEA2, (1)Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT, (2)University of Utah Health Sciences Center, Salt Lake City, UT, (3)Centers for Disease Control and Prevention, Atlanta, GA, (4)Vanderbilt University School of Medicine, Nashville, TN, (5)Northwestern University Feinberg School of Medicine, Chicago, IL, (6)Univ. of Tennessee, Memphis, TN, (7)St. Jude Children's Research Hospital, Memphis, TN

    Disclosures:

    K. Ampofo, None

    C. Stockmann, None

    A. Blaschke, BioFire Diagnostics, Inc.: Collaborator, Licensing agreement or royalty

    M. D. G. Carvalho, None

    A. M. Bramley, None

    D. J. Williams, None

    W. H. Self, None

    K. Edwards, None

    C. G. Grijalva, None

    Y. Zhu, None

    E. J. Anderson, None

    R. G. Wunderink, None

    M. Courtney, None

    C. Qi, None

    S. Arnold, None

    J. A. Mccullers, None

    L. Hicks, None

    D. Erdman, None

    A. L. Hersh, None

    C. L. Byington, BioFire Diagnostics: Collaborator and Grant Investigator, Grant recipient and Licensing agreement or royalty

    S. Jain, None

    A. Pavia, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.