A practical approach estimating etiologic agents using real-time PCR in pediatric inpatients with community-acquired pneumonia

作者：Okada Takafumi^*; Morozumi Miyuki; Sakata Hiroshi; Takayanagi Reiko; Ishiwada Naruhiko; Sato Yoshitake; Oishi Tomohiro; Tajima Takeshi; Haruta Tunekazu; Kawamura Naohisa; Ouchi Kazunobu; Matsubara Keita; Chiba Naoko; Takahashi Takashi; Iwata Satoshi; Ubukata Kimiko

来源：Journal of Infection and Chemotherapy, 2012, 18(6): 832-840.

DOI：10.1007/s10156-012-0422-7

• Real-time PCR
• Community-acquired pneumonia
• Pediatric inpatient
• Comprehensive detection
• Etiologic agents

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.

• 出版日期2012-12