Molecular analysis improves pathogen identification and epidemiologic study of pediatric parapneumonic empyema

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Published on: February 24, 2023

Anne J Blaschke1, Caroline Heyrend, Carrie L Byington

  • 1Department of Pediatrics, University of Utah, Salt, Lake City, UT, USA. anne.blaschke@hsc.utah.edu

The Pediatric Infectious Disease Journal
|November 9, 2010
PubMed
Abstract

Insights

Molecular analysis of pleural fluid significantly increased pathogen detection in children with parapneumonic empyema (PPE). Streptococcus pneumoniae was the most common pathogen identified, even in culture-negative cases.

Area of Science:

  • Pediatric infectious diseases
  • Molecular microbiology
  • Epidemiology of respiratory infections

Background:

  • Parapneumonic empyema (PPE) is a growing concern in pediatric bacterial pneumonia.
  • Traditional culture methods often yield low pathogen detection rates, complicating epidemiological studies.
  • Molecular techniques offer a promising approach to identify causative agents in PPE.

Purpose of the Study:

  • To investigate the epidemiology of pediatric parapneumonic empyema using molecular analysis of pleural fluid.
  • To compare the diagnostic yield of molecular testing versus traditional culture methods for identifying bacterial pathogens in PPE.
  • To characterize the common pathogens and serotypes involved in pediatric PPE.

Main Methods:

  • Archived pleural fluid samples from children hospitalized with PPE in 2009 were analyzed.
  • Real-time polymerase chain reaction (PCR) was employed to detect key bacterial pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Mycoplasma pneumoniae.
  • PCR-based serotyping was used for Streptococcus pneumoniae, alongside abstraction of demographic, laboratory, and microbiologic data.

Main Results:

  • Molecular testing detected pathogens in 84% of cases, a significant increase from 35% with culture alone.
  • Streptococcus pneumoniae was identified in 71% of cases by PCR, compared to 24% by culture.
  • PCR significantly enhanced the detection of S. pneumoniae and other pathogens, revealing differences in pathogen profiles and outcomes between culture-positive and culture-negative PPE.

Conclusions:

  • Molecular analysis of pleural fluid substantially improves pathogen detection rates in pediatric parapneumonic empyema.
  • Streptococcus pneumoniae remains the predominant pathogen in both culture-positive and culture-negative PPE.
  • Differences in serotype distribution and clinical outcomes were observed between culture-positive and culture-negative disease.

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