title: A practical approach estimating etiologic agents using real-time PCR in pediatric inpatients with community-acquired pneumonia.
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.
authors.affiliation: Department of Pediatrics, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan. tokada@ntmc.hosp.go.jp
authors.forename: Takafumi
authors.initials: T
authors.lastname: Okada
authors.forename: Miyuki
authors.initials: M
authors.lastname: Morozumi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakata
authors.forename: Reiko
authors.initials: R
authors.lastname: Takayanagi
authors.forename: Naruhiko
authors.initials: N
authors.lastname: Ishiwada
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Sato
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Oishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tajima
authors.forename: Tunekazu
authors.initials: T
authors.lastname: Haruta
authors.forename: Naohisa
authors.initials: N
authors.lastname: Kawamura
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Ouchi
authors.forename: Keita
authors.initials: K
authors.lastname: Matsubara
authors.forename: Naoko
authors.initials: N
authors.lastname: Chiba
authors.forename: Takashi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iwata
authors.forename: Kimiko
authors.initials: K
authors.lastname: Ubukata
mesh_terms: D001419:Bacteria / Q000235:genetics / Q000302:isolation & purification; D001424:Bacterial Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D011014:Pneumonia / Q000097:blood / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D014777:Virus Diseases / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification
chemical_list: D002097:C-Reactive Protein