Pleural antigen assay in the diagnosis of pediatric pneumococcal empyema

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• 作者：Federico Martinó ; n-Torres ; MD ; PhD^a ; ^b ; ^{federico.martinon.torres@sergas.es} ; Silvia Dosil-Gallardo ; MD^a ; ^b ; Marí ; a Luisa Perez del Molino-Bernal ; PhD^c ; Fernanda Pardo Sá ; nchez ; PhD^c ; David Tarrago ; PhD^d ; Fernando Alvez ; MD ; PhD^e ; Sonia Pertega Diaz^f ; Nazareth Martinó ; n-Torres ; MD^a ; ^b ; Jose Maria Martinon Sanchez ; MD ; PhD ; Prof.^a ; ^b
• 关键词：Empyema ; Children ; Pleural effusion ; Streptococcus pneumoniae ; Immunochromatographic test ; Diagnosis
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：321.e1-321.e4
• 文件大小：114 K

摘要

Purpose

The purpose of the study was to assess the diagnostic value of rapid pneumococcal antigen detection (PAD) in pleural fluid samples of children with empyema.

Material and Methods

We performed a prospective evaluation in a pediatric intensive care unit of a tertiary university hospital of children aged 1 month to 14 years admitted with empyema. Standard cultures (conventional microbiological culture [CMC]), PAD by immunochromatographic testing (Binax NOW Streptococcus pneumoniae; Binax, Portland, ME), and/or real-time polymerase chain reactions (RTPs) on pleural samples were performed in all included patients.

Results

Fifty-five cases with a mean (SD) age of 6.5 (6.1) years were enrolled. Streptococcus pneumoniae was identified in 28 cases (51%): by CMC in 15 cases and by RTP in a further 13 cases. Using CMC and/or RTP as the criterion standard, PAD showed a sensitivity of 96%(95%confidence interval, 86%-100%), a specificity of 100%(75%-100%), a positive predictive value of 100%(98%-100%), and a Youden index of 0.96 (0.88-1.04).

Conclusions

Pneumococcal antigen detection in pleural fluid specimens from children provides a rapid, simple, sensitive, and reliable method of diagnosis for pneumococcal empyema at bedside.