摘要
Background: An increase in the incidence of thoracic empyema in children has b een reported. The causative pathogen is often unknown as pleural fluid is freque ntly sterile at the time of culture. The role of unusual organisms is unclear. A ims: (1) To compare the detection of organisms in pleural fluid from children wi th empyema using amolecular technique (16S rDNA polymerase chain reaction (PCR)) and bacterial culture. (2) To compare the concordance of organisms identified u sing the two techniques and the influence of prior antibiotic treatment on posit ive detection rate. Methods: Pleural fluid from children admitted with empyema b etween January 2000 and February 2002 was cultured and additionally analysed usi ng broad range 16S rDNA PCR. Results: Pleural fluid was cultured from 32 patient s, aged 1 month-16 years. Median duration of previous antibiotic therapy was 8 days (range 1-42 days). Six samples were culture positive and 22 were PCR posit ive. Acausal organism was detected by PCR alone, after considering results from the local hospital, in 14 patients. There was complete concordance in organisms cultured and detected by PCR. Additional organisms detected by PCR were predomin antly S pneumoniae, S pyogenes, and anaerobes. Conclusions: Analysis of pleural fluid by broad range 16S rDNA PCR in addition to culture, increases organism ide ntification in empyema.
Background: An increase in the incidence of thoracic empyema in children has b een reported. The causative pathogen is often unknown as pleural fluid is freque ntly sterile at the time of culture. The role of unusual organisms is unclear. A ims: (1) To compare the detection of organisms in pleural fluid from children wi th empyema using amolecular technique (16S rDNA polymerase chain reaction (PCR)) and bacterial culture. (2) To compare the concordance of organisms identified u sing the two techniques and the influence of prior antibiotic treatment on posit ive detection rate. Methods: Pleural fluid from children admitted with empyema b etween January 2000 and February 2002 was cultured and additionally analysed usi ng broad range 16S rDNA PCR. Results: Pleural fluid was cultured from 32 patient s, aged 1 month-16 years. Median duration of previous antibiotic therapy was 8 days (range 1-42 days). Six samples were culture positive and 22 were PCR posit ive. Acausal organism was detected by PCR alone, after considering results from the local hospital, in 14 patients. There was complete concordance in organisms cultured and detected by PCR. Additional organisms detected by PCR were predomin antly S pneumoniae, S pyogenes, and anaerobes. Conclusions: Analysis of pleural fluid by broad range 16S rDNA PCR in addition to culture, increases organism ide ntification in empyema.
