Pleural fluid nucleic acid testing enhances pneumococcal surveillance in children
ROXANNE. E. STRACHAN
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
Search for more papers by this authorANITA CORNELIUS
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
Search for more papers by this authorGWENDOLYN. L. GILBERT
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead
Search for more papers by this authorTANYA GULLIVER
Paediatric/Respiratory Department, John Hunter Hospital, Newcastle
Search for more papers by this authorANDREW MARTIN
Department of General Paediatrics, Princess Margaret Hospital for Children, Perth
Search for more papers by this authorTIM MCDONALD
Department of Paediatrics and Child Health, The Canberra Hospital, Canberra
Search for more papers by this authorGILLIAN NIXON
Department of Respiratory and Sleep Medicine, Monash Medical Centre and Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Melbourne
Search for more papers by this authorROB ROSEBY
Department of Paediatrics, Alice Springs Hospital, Alice Springs
Search for more papers by this authorSARATH RANGANATHAN
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne
Search for more papers by this authorHIRAN SELVADURAI
Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney
Search for more papers by this authorGREG SMITH
Department of Pulmonary Medicine, Women's and Children's Hospital, North Adelaide
Search for more papers by this authorMANUEL SOTO-MARTINEZ
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne
Search for more papers by this authorSADASIVAM SURESH
Department of Respiratory/Sleep Medicine, Mater Children's Hospital, South Brisbane
Search for more papers by this authorLAUREL TEOH
Department of Paediatrics and Child Health, The Canberra Hospital, Canberra
Search for more papers by this authorKIRAN THAPA
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead
Search for more papers by this authorCLAIRE E. WAINWRIGHT
Queensland Children's Medical Research Institute, University of Queensland, Brisbane
Search for more papers by this authorCorresponding Author
ADAM JAFFÉ
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
Adam Jaffe, Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick, Sydney NSW 2031, Australia. Email: [email protected]Search for more papers by this authorROXANNE. E. STRACHAN
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
Search for more papers by this authorANITA CORNELIUS
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
Search for more papers by this authorGWENDOLYN. L. GILBERT
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead
Search for more papers by this authorTANYA GULLIVER
Paediatric/Respiratory Department, John Hunter Hospital, Newcastle
Search for more papers by this authorANDREW MARTIN
Department of General Paediatrics, Princess Margaret Hospital for Children, Perth
Search for more papers by this authorTIM MCDONALD
Department of Paediatrics and Child Health, The Canberra Hospital, Canberra
Search for more papers by this authorGILLIAN NIXON
Department of Respiratory and Sleep Medicine, Monash Medical Centre and Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Melbourne
Search for more papers by this authorROB ROSEBY
Department of Paediatrics, Alice Springs Hospital, Alice Springs
Search for more papers by this authorSARATH RANGANATHAN
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne
Search for more papers by this authorHIRAN SELVADURAI
Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney
Search for more papers by this authorGREG SMITH
Department of Pulmonary Medicine, Women's and Children's Hospital, North Adelaide
Search for more papers by this authorMANUEL SOTO-MARTINEZ
Department of Respiratory Medicine, Royal Children's Hospital, Melbourne
Search for more papers by this authorSADASIVAM SURESH
Department of Respiratory/Sleep Medicine, Mater Children's Hospital, South Brisbane
Search for more papers by this authorLAUREL TEOH
Department of Paediatrics and Child Health, The Canberra Hospital, Canberra
Search for more papers by this authorKIRAN THAPA
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead
Search for more papers by this authorCLAIRE E. WAINWRIGHT
Queensland Children's Medical Research Institute, University of Queensland, Brisbane
Search for more papers by this authorCorresponding Author
ADAM JAFFÉ
Department of Respiratory Medicine, Sydney Children's Hospital, Randwick
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
Adam Jaffe, Department of Respiratory Medicine, Sydney Children's Hospital, High Street, Randwick, Sydney NSW 2031, Australia. Email: [email protected]Search for more papers by this authorConflict of Interest statement: This study was funded through an unrestricted grant from GlaxoSmithKline, Belgium.
ABSTRACT
Background and objective: National surveillance of invasive pneumococcal disease (IPD) includes serotyping Streptococcus pneumoniae (SP) isolates from sterile site cultures. PCR is more sensitive and can identify more SP serotypes (STs) in culture-negative samples. The aim of this study was to determine whether enhanced surveillance of childhood empyema, using PCR, provides additional serotype information compared with conventional surveillance.
Methods: Pleural fluid (PF) from children with empyema were cultured and tested by PCR to identify SP, targeting the autolysin gene (lytA). Multiplex PCR-based reverse line blot assay was used to identify SP STs. Corresponding IPD surveillance and serotype data were obtained from the National Notifiable Diseases Surveillance System (NNDSS).
Results: Eighty-nine children with empyema, aged ≤16 years, were recruited between April 2008 and March 2009, inclusive. SP was isolated from 5/84 (5.9%) PF cultures and by PCR in 43/79 (54.4%) PF samples. Serotypes were unidentifiable in 15 samples. The frequency of six serotypes (or serotype pairs) identified in 28 samples, including one with two serotypes, were: ST1, n = 4/29 (13.8%); ST3, n = 9/29 (31.0%); ST19A, n = 12/29 (41.4%); ST7F/7A, n = 1/29 (3.4%); ST9V/9A, n = 1/29 (3.4%); ST22F/22A, n = 2/29 (6.9%). Over the same period, 361 IPD patients, aged 16 years or less, were notified to NNDSS. Among 331 serotypeable NNDSS isolates (71.5% from blood), the frequencies of ST1 and 3 were significantly lower than in PF samples: ST1, n = 8/331 (2.4%; P < 0.05); ST3, n = 13/331 (3.9%; P < 0.0001).
Conclusions: The use of PCR to identify and serotype SP in culture-negative specimens provides additive information.
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