Journal Article

Community-Acquired Bacteremic Pneumococcal Pneumonia in Children: Diagnosis and Serotyping by Real-Time Polymerase Chain Reaction Using Blood Samples

Massimo Resti, Maria Moriondo, Martina Cortimiglia, Giuseppe Indolfi, Clementina Canessa, Laura Becciolini, Elisa Bartolini, Fernando Maria de Benedictis, Maurizio de Martino and Chiara Azzari

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 9, pages 1042-1049
Published in print November 2010 | ISSN: 1058-4838
Published online November 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/656579
Community-Acquired Bacteremic Pneumococcal Pneumonia in Children: Diagnosis and Serotyping by Real-Time Polymerase Chain Reaction Using Blood Samples

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Background. The aim of this study was to use real-time polymerase chain reaction (RT-PCR) on blood samples to diagnose and serotype pneumococcal infection in a large cohort of Italian children hospitalized for communityacquired pneumonia.

Methods. We conducted an observational study from April 2007 through June 2009 of children aged 0–16 years with a diagnosis of community-acquired pneumonia admitted to 83 pediatric hospitals in Italy.

Results. Seven hundred fifty-th ee children were studied. RT-PCR found pneumococcal infection in 80 (10.6%) of 753 patients. In 292 patients, culture and RT-PCR were simultaneously performed. Streptococcus pneumoniae was identifie in 47 of 292 patients; 45 (15.4%) tested positive by RT-PCR and 11 (3.8%) tested positive by culture. RT-PCR was significantl more sensitive than culture in revealing bacteremic pneumonia (odds ratio, 30.6; 95% confidenc interval, 5.8–97.5; P < .001). Complicated pneumonia was found in 162 (21.5%) of 753 children; 152 (93.8%) of these 162 had parapneumonic effusion, and 51 (33.6%) had empyema. Children with complicated pneumonia were significantl older. Pneumococcal bacteremia was found by RT-PCR to occur signif cantly more frequently in children with complications (38 [23.5%] of 162) than in children with uncomplicated pneumonia (44 [7.4%] of 591; odds ratio, 3.8; 95% confidenc interval, 2.30–6.30; P < .001). RT-PCR allowed serotyping from blood in 92.5% of patients. More than two-thirds of the pneumonia cases were due to nonpneumococcal conjugate vaccine 7 serotypes. Serotype 1 was the most frequent serotype (26 [32.5%] of 80) and was signifi antly associated with complications (50.0% in patients with complicated pneumonia vs 18.2% in patients with uncomplicated pneumonia; odds ratio, 4.5, 95% confidenc interval, 1.48–14.03; P = .005) and older age. Serotype 19A was second in frequency (15.0%) and was significantl associated with younger age.

Conclusions. RT-PCR allows diagnosis and serotyping of pneumococcal bacteremic community-acquired pneumonia in children and is an important tool for evaluating serotype distribution in culture-negative samples.

Journal Article.  4765 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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