Identification of pathogens by comprehensive real-time PCR versus conventional methods in community-acquired pneumonia in Japanese adults. Issue 11 (1st December 2016)

• Record Type: Journal Article
• Authors: Yoshii, Yutaka; Shimizu, Kenichiro; Morozumi, Miyuki; Chiba, Naoko; Ubukata, Kimiko; Uruga, Hironori; Hanada, Shigeo; Wakui, Hiroshi; Ito, Saburo; Takasaka, Naoki; Minagawa, Shunsuke; Kojima, Jun; Numata, Takanori; Hara, Hiromichi; Kawaishi, Makoto; Saito, Keisuke; Araya, Jun; Kaneko, Yumi; Nakayama, Katsutoshi; Kishi, Kazuma; Kuwano, Kazuyoshi
• Is Part Of: Infectious diseases. Volume 48:Issue 11/12(2016:Nov./Dec.)
• Page Start: 782
• Page End: 788
• Publication Date: 2016-12-01
• Subjects: Community-acquired pneumonia -- mixed infection -- pneumococcal pneumonia -- real-time polymerase chain reaction; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1080/23744235.2016.1193788
• Languages: English
• ISSNs: 2374-4235

Abstract

Abstract: Background: Community-acquired pneumonia (CAP) has high morbidity and mortality. Unfortunately, the pathogen detection rate using conventional culture methods is relatively low. We compared comprehensive real-time polymerase chain reaction (real-time PCR) analysis of nasopharyngeal swab specimens (NPS) and sputum samples against conventional methods for ability to detect causative pathogens of CAP. Methods: We prospectively enrolled adult CAP patients, including those with prior antibiotic use, from December 2012 to May 2014. For each patient, causative pathogens were investigated conventionally and by real-time PCR that can identify 6 bacterial and 11 viral pathogens. Results: Patients numbered 92 (mean age, 63 years; 59 male), including 30 (33%) with prior antibiotic use. Considering all patients, identification of causative pathogens by real-time PCR was significantly more frequent than by conventional methods in all patients (72% vs. 57%, p = 0.018). In patients with prior antibiotic use, identification rates also differed significantly (PCR, 77%; conventional, 50%; p = 0.027). Mixed infections were more frequent according to real-time PCR than conventional methods (26% vs. 4%, p < 0.001). By the real-time PCR, Streptococcus pneumoniae was most frequently identified (38%) as a causative pathogen, followed by Haemophilus influenzae (37%) and Mycoplasma pneumoniae (5%). PCR also identified viral pathogens (21%), with sensitivity enhanced by simultaneous examination of both NPS and sputum samples rather than only NPS samples. Conclusions: Real-time PCR of NPS and sputum samples could better identify bacterial and viral pathogens in CAP than conventional methods, both overall and in patients with prior antibiotic treatment.