Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture

Eiichi Nakayama, Keiko Hasegawa, Miyuki Morozumi, Reiko Kobayashi, Naoko Chiba, Taketoshi Iitsuka, Takeshi Tajima, Keisuke Sunakawa, Kimiko Ubukata

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Children (n = 117; mean age 2.4 ± 2.9 years) were diagnosed as having community-acquired pneumonia (CAP) using clinical symptoms, chest X-rays, and hematological data. The causative pathogen was determined using real-time polymerase chain reaction (PCR) (6 bacteria), multiple reverse transcription-PCR (MPCR; 11 viruses), bacterial culture, and serology. The initial chemotherapy was evaluated based on the pathogens identified using PCR. We found 27 viral cases (23.1%), 25 bacterial cases (21.4%), 45 mixed infections with virus and bacteria (38.5%), 10 Mycoplasma pneumoniae (8.5%), 7 mixed infections with M. pneumoniae and another pathogen (6.0%), 1 Chlamydophila pneumoniae (0.9%), and 2 unknown pathogens (1.7%). Streptococcus pneumoniae and Haemophilus influenzae accounted for 58 (49.5%) and 27 (23.0%) of the cases, respectively. The median values (50%) of the white blood cell count (WBC) and C-reactive protein (CRP) using the box-and-whisker and plot method, respectively, were 11.7 × 103 mm-3 and 1.4 mg/dl in viral infections, 15.6 × 103 mm-3 and 4.8 mg/dl in mixed infections with virus and bacteria, 17.8 × 103 mm-3 and 6.3 mg/dl in bacterial infections, 6.7 × 103 mm-3 and 1.4 mg/dl in M. pneumoniae infections, and 21.5 × 103 mm-3 and 6.4 mg/dl in mixed infections with M. pneumoniae and other bacterial infections. Sulbactam/ampicillin (n = 61), carbapenems (n = 12), and ceftriaxone (n = 7) were selected for the patients suspected of having bacterial infections alone or mixed infections with bacterial and viruses in accordance with our criteria defined tentatively. For those with M. pneumoniae and C. pneumoniae infections, azithromycin or minocycline was initially used. Treatments averaged 3-5 days. The empirical chemotherapy was improper in 9.4% of cases in relation to the etiologic agents finally identified. We conclude that rapid and comprehensive identification using PCR can provide optimal antimicrobial chemotherapy for CAP patients.

Original languageEnglish
Pages (from-to)305-313
Number of pages9
JournalJournal of Infection and Chemotherapy
Volume13
Issue number5
DOIs
Publication statusPublished - 2007 Oct
Externally publishedYes

Fingerprint

Mycoplasma pneumoniae
Serology
Coinfection
Pneumonia
Pediatrics
Drug Therapy
Polymerase Chain Reaction
Bacterial Infections
Viruses
Chlamydophila pneumoniae
Bacteria
Vibrissae
Minocycline
Azithromycin
Carbapenems
Ceftriaxone
Haemophilus influenzae
Virus Diseases
Streptococcus pneumoniae
Infection

Keywords

  • Antimicrobial chemotherapy
  • C-Reactive protein
  • Child
  • Community-acquired pneumonia

ASJC Scopus subject areas

  • Microbiology (medical)

Cite this

Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture. / Nakayama, Eiichi; Hasegawa, Keiko; Morozumi, Miyuki; Kobayashi, Reiko; Chiba, Naoko; Iitsuka, Taketoshi; Tajima, Takeshi; Sunakawa, Keisuke; Ubukata, Kimiko.

In: Journal of Infection and Chemotherapy, Vol. 13, No. 5, 10.2007, p. 305-313.

Research output: Contribution to journalArticle

Nakayama, Eiichi ; Hasegawa, Keiko ; Morozumi, Miyuki ; Kobayashi, Reiko ; Chiba, Naoko ; Iitsuka, Taketoshi ; Tajima, Takeshi ; Sunakawa, Keisuke ; Ubukata, Kimiko. / Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture. In: Journal of Infection and Chemotherapy. 2007 ; Vol. 13, No. 5. pp. 305-313.
@article{bad0c1e4009440888757929bcc617315,
title = "Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture",
abstract = "Children (n = 117; mean age 2.4 ± 2.9 years) were diagnosed as having community-acquired pneumonia (CAP) using clinical symptoms, chest X-rays, and hematological data. The causative pathogen was determined using real-time polymerase chain reaction (PCR) (6 bacteria), multiple reverse transcription-PCR (MPCR; 11 viruses), bacterial culture, and serology. The initial chemotherapy was evaluated based on the pathogens identified using PCR. We found 27 viral cases (23.1{\%}), 25 bacterial cases (21.4{\%}), 45 mixed infections with virus and bacteria (38.5{\%}), 10 Mycoplasma pneumoniae (8.5{\%}), 7 mixed infections with M. pneumoniae and another pathogen (6.0{\%}), 1 Chlamydophila pneumoniae (0.9{\%}), and 2 unknown pathogens (1.7{\%}). Streptococcus pneumoniae and Haemophilus influenzae accounted for 58 (49.5{\%}) and 27 (23.0{\%}) of the cases, respectively. The median values (50{\%}) of the white blood cell count (WBC) and C-reactive protein (CRP) using the box-and-whisker and plot method, respectively, were 11.7 × 103 mm-3 and 1.4 mg/dl in viral infections, 15.6 × 103 mm-3 and 4.8 mg/dl in mixed infections with virus and bacteria, 17.8 × 103 mm-3 and 6.3 mg/dl in bacterial infections, 6.7 × 103 mm-3 and 1.4 mg/dl in M. pneumoniae infections, and 21.5 × 103 mm-3 and 6.4 mg/dl in mixed infections with M. pneumoniae and other bacterial infections. Sulbactam/ampicillin (n = 61), carbapenems (n = 12), and ceftriaxone (n = 7) were selected for the patients suspected of having bacterial infections alone or mixed infections with bacterial and viruses in accordance with our criteria defined tentatively. For those with M. pneumoniae and C. pneumoniae infections, azithromycin or minocycline was initially used. Treatments averaged 3-5 days. The empirical chemotherapy was improper in 9.4{\%} of cases in relation to the etiologic agents finally identified. We conclude that rapid and comprehensive identification using PCR can provide optimal antimicrobial chemotherapy for CAP patients.",
keywords = "Antimicrobial chemotherapy, C-Reactive protein, Child, Community-acquired pneumonia",
author = "Eiichi Nakayama and Keiko Hasegawa and Miyuki Morozumi and Reiko Kobayashi and Naoko Chiba and Taketoshi Iitsuka and Takeshi Tajima and Keisuke Sunakawa and Kimiko Ubukata",
year = "2007",
month = "10",
doi = "10.1007/s10156-007-0535-6",
language = "English",
volume = "13",
pages = "305--313",
journal = "Journal of Infection and Chemotherapy",
issn = "1341-321X",
publisher = "Elsevier BV",
number = "5",

}

TY - JOUR

T1 - Rapid optimization of antimicrobial chemotherapy given to pediatric patients with community-acquired pneumonia using PCR techniques with serology and standard culture

AU - Nakayama, Eiichi

AU - Hasegawa, Keiko

AU - Morozumi, Miyuki

AU - Kobayashi, Reiko

AU - Chiba, Naoko

AU - Iitsuka, Taketoshi

AU - Tajima, Takeshi

AU - Sunakawa, Keisuke

AU - Ubukata, Kimiko

PY - 2007/10

Y1 - 2007/10

N2 - Children (n = 117; mean age 2.4 ± 2.9 years) were diagnosed as having community-acquired pneumonia (CAP) using clinical symptoms, chest X-rays, and hematological data. The causative pathogen was determined using real-time polymerase chain reaction (PCR) (6 bacteria), multiple reverse transcription-PCR (MPCR; 11 viruses), bacterial culture, and serology. The initial chemotherapy was evaluated based on the pathogens identified using PCR. We found 27 viral cases (23.1%), 25 bacterial cases (21.4%), 45 mixed infections with virus and bacteria (38.5%), 10 Mycoplasma pneumoniae (8.5%), 7 mixed infections with M. pneumoniae and another pathogen (6.0%), 1 Chlamydophila pneumoniae (0.9%), and 2 unknown pathogens (1.7%). Streptococcus pneumoniae and Haemophilus influenzae accounted for 58 (49.5%) and 27 (23.0%) of the cases, respectively. The median values (50%) of the white blood cell count (WBC) and C-reactive protein (CRP) using the box-and-whisker and plot method, respectively, were 11.7 × 103 mm-3 and 1.4 mg/dl in viral infections, 15.6 × 103 mm-3 and 4.8 mg/dl in mixed infections with virus and bacteria, 17.8 × 103 mm-3 and 6.3 mg/dl in bacterial infections, 6.7 × 103 mm-3 and 1.4 mg/dl in M. pneumoniae infections, and 21.5 × 103 mm-3 and 6.4 mg/dl in mixed infections with M. pneumoniae and other bacterial infections. Sulbactam/ampicillin (n = 61), carbapenems (n = 12), and ceftriaxone (n = 7) were selected for the patients suspected of having bacterial infections alone or mixed infections with bacterial and viruses in accordance with our criteria defined tentatively. For those with M. pneumoniae and C. pneumoniae infections, azithromycin or minocycline was initially used. Treatments averaged 3-5 days. The empirical chemotherapy was improper in 9.4% of cases in relation to the etiologic agents finally identified. We conclude that rapid and comprehensive identification using PCR can provide optimal antimicrobial chemotherapy for CAP patients.

AB - Children (n = 117; mean age 2.4 ± 2.9 years) were diagnosed as having community-acquired pneumonia (CAP) using clinical symptoms, chest X-rays, and hematological data. The causative pathogen was determined using real-time polymerase chain reaction (PCR) (6 bacteria), multiple reverse transcription-PCR (MPCR; 11 viruses), bacterial culture, and serology. The initial chemotherapy was evaluated based on the pathogens identified using PCR. We found 27 viral cases (23.1%), 25 bacterial cases (21.4%), 45 mixed infections with virus and bacteria (38.5%), 10 Mycoplasma pneumoniae (8.5%), 7 mixed infections with M. pneumoniae and another pathogen (6.0%), 1 Chlamydophila pneumoniae (0.9%), and 2 unknown pathogens (1.7%). Streptococcus pneumoniae and Haemophilus influenzae accounted for 58 (49.5%) and 27 (23.0%) of the cases, respectively. The median values (50%) of the white blood cell count (WBC) and C-reactive protein (CRP) using the box-and-whisker and plot method, respectively, were 11.7 × 103 mm-3 and 1.4 mg/dl in viral infections, 15.6 × 103 mm-3 and 4.8 mg/dl in mixed infections with virus and bacteria, 17.8 × 103 mm-3 and 6.3 mg/dl in bacterial infections, 6.7 × 103 mm-3 and 1.4 mg/dl in M. pneumoniae infections, and 21.5 × 103 mm-3 and 6.4 mg/dl in mixed infections with M. pneumoniae and other bacterial infections. Sulbactam/ampicillin (n = 61), carbapenems (n = 12), and ceftriaxone (n = 7) were selected for the patients suspected of having bacterial infections alone or mixed infections with bacterial and viruses in accordance with our criteria defined tentatively. For those with M. pneumoniae and C. pneumoniae infections, azithromycin or minocycline was initially used. Treatments averaged 3-5 days. The empirical chemotherapy was improper in 9.4% of cases in relation to the etiologic agents finally identified. We conclude that rapid and comprehensive identification using PCR can provide optimal antimicrobial chemotherapy for CAP patients.

KW - Antimicrobial chemotherapy

KW - C-Reactive protein

KW - Child

KW - Community-acquired pneumonia

UR - http://www.scopus.com/inward/record.url?scp=35848936726&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35848936726&partnerID=8YFLogxK

U2 - 10.1007/s10156-007-0535-6

DO - 10.1007/s10156-007-0535-6

M3 - Article

VL - 13

SP - 305

EP - 313

JO - Journal of Infection and Chemotherapy

JF - Journal of Infection and Chemotherapy

SN - 1341-321X

IS - 5

ER -