Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Authors:
Publisher website
Google Scholar
Abstract
Objective: To evaluate culture‐independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture‐negative pleural fluid (PF) in children.Method: Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture‐independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real‐time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β‐lactam agents, in PF samples.Results: We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods.From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty‐four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving β‐lactam antibiotics administered empirically. Of the 24 lytA real‐time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of β‐lactam susceptibility.Conclusion: The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of β‐lactam susceptibility should be explored further.

This publication has 35 references indexed in Scilit: