A practical approach estimating etiologic agents using real-time PCR in pediatric inpatients with community-acquired
Takafumi Okada1, Miyuki Morozumi, Hiroshi Sakata
1Department of Pediatrics, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan. tokada@ntmc.hosp.go.jp
Insights
This study found real-time PCR and blood tests effectively identify pathogens in pediatric community-acquired pneumonia (CAP). Results help determine if viral or bacterial infections are the cause in hospitalized children.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Molecular Diagnostics
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness requiring accurate etiological diagnosis.
- Identifying causative pathogens is crucial for effective treatment and management of pediatric CAP.
- Current diagnostic methods may not always provide rapid or comprehensive pathogen identification.
Purpose of the Study:
- To evaluate a rapid diagnostic approach for identifying pathogens in hospitalized children with CAP.
- To assess the utility of real-time PCR on nasopharyngeal swabs combined with blood tests.
- To stratify pathogen prevalence based on patient age.
Main Methods:
- A prospective study involving 903 pediatric inpatients with CAP across ten Japanese institutions.
- Real-time PCR was used to detect 6 bacteria and 11 respiratory viruses in nasopharyngeal swabs.
- Bacterial cultures and blood tests were also performed; pathogen identification considered clinical data and antimicrobial efficacy.
Main Results:
- Pathogens were identified in 81.6% of cases; viral infections were most common (34.4%), followed by bacterial (21.8%) and co-infections (17.5%).
- Mycoplasmal infections were more prevalent in older children (≥6 years), while viral infections predominated in infants (<1 year).
- Real-time PCR and blood test combination proved useful in estimating etiologic agents in a clinical setting.
Conclusions:
- Real-time PCR on nasopharyngeal samples, complemented by blood tests, offers a valuable tool for rapid pathogen detection in pediatric CAP.
- Age-specific pathogen patterns were observed, aiding in etiological diagnosis.
- This integrated diagnostic strategy enhances the ability to determine causative agents for CAP in hospitalized children.
Abstract:
To evaluate pathogens in pediatric inpatients with community-acquired pneumonia (CAP), an Acute Respiratory Diseases Study Group organized by ten Japanese medical institutions devised a rapid, reliable process based on real-time PCR results in nasopharyngeal swab samples plus admission blood test results. From April 2008 to April 2009, we enrolled 903 children with CAP based on chest radiographs and clinical findings who were hospitalized within 5 days of onset. Comprehensive real-time PCR was used to detect 6 bacteria and 11 respiratory viruses. The swab specimens also were used for bacterial cultures. After initial determination of presence or absence of viral and mycoplasmal infections, significant bacterial contributions were defined by bacterial identification, clinical efficacy of antimicrobial agent, and reference to blood test results. Children were stratified by age: below 1 year, 1 year, 2-5 years, or at least 6 years old. Among patients studied, 34.4 % were diagnosed with viral infection; 21.8 %, bacterial infection; 17.5 %, viral/bacterial co-infection; 5.9 %, mycoplasmal infection; 0.3 %, mycoplasmal/bacterial co-infection; and 1.7 %, viral/mycoplasmal co-infection. The remaining 18.4 % had unknown pathogens. Purely viral infection was suggested mainly in infants younger than 1 year; mycoplasmal infection typically occurred in children at least 6 years old. Our results suggest usefulness of real-time PCR for nasopharyngeal samples together with blood tests in estimating etiologic agents in clinical settings.
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