title: Culture negative empyema in a critically ill child: an opportunity for rapid molecular diagnostics.
abstract: BACKGROUND
  Nucleic acid amplification technologies (NAAT) are advancing our ability to make rapid molecular diagnoses in patients with serious culture negative infections. This is the first report of PCR coupled to electrospray ionization mass spectrometry use in the evaluation of complicated community acquired pneumonia in a pediatric patient.
  
  
  METHODS
  We present a case of culture negative empyema in a critically ill, Caucasian, 2-year-old girl who was treated with broad-spectrum empiric antibiotics, in which the length of stay was prolonged by adverse effects of the empiric antibiotic treatment. PCR coupled to electrospray ionization mass spectrometry was applied to culture negative fluid and tissue samples from the patient in order to determine the etiology of the empyema.
  
  
  CONCLUSIONS
  Using this method, Streptococcus mitis/viridans was identified as the pathogen. A retrospective review of cases of empyema in children at our institution found that 87.5% of cases were negative for identification of a pathogen and antibiotics were administered to 100% of cases prior to collecting pleural fluid for culture. Understanding the role of Streptococcus mitis/viridans group in the etiology of empyema using an advanced NAAT coupled with mass spectrometry can enlighten clinicians as to the impact of this pathogen in community acquired pneumonia and help assist with antibiotic stewardship.
authors.affiliation: Departments of Medicine & Pediatrics, University of Illinois School of Medicine, 530 N.E. Glen Oak Ave, Peoria, IL 61603 USA.
authors.forename: Elsa L
authors.initials: EL
authors.lastname: Vazquez Melendez
authors.affiliation: Department of Medicine, University of Illinois School of Medicine, Peoria, IL USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Farrell
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, 10701 East Blvd, Cleveland, Ohio 44106 USA ; Department of Medicine, Case Western Reserve University, Cleveland, OH USA.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Hujer
authors.affiliation: Ibis Biosciences, an Abbott Company, Carlsbad, CA USA.
authors.forename: Kristin S
authors.initials: KS
authors.lastname: Lowery
authors.affiliation: Ibis Biosciences, an Abbott Company, Carlsbad, CA USA.
authors.forename: Rangarajan
authors.initials: R
authors.lastname: Sampath
authors.affiliation: Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Research Service, 10701 East Blvd, Cleveland, Ohio 44106 USA ; Department of Medicine, Case Western Reserve University, Cleveland, OH USA ; Departments of Pharmacology and Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, OH USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016638:Critical Illness; D004653:Empyema / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D025202:Molecular Diagnostic Techniques / Q000379:methods; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D016133:Polymerase Chain Reaction; D021241:Spectrometry, Mass, Electrospray Ionization / Q000379:methods; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D034361:Streptococcus mitis / Q000302:isolation & purification; D034363:Viridans Streptococci / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship; Culture negative infection; Empyema; Pediatric infection