Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study
Abstract Background Readily-available diagnostics do not reliably discriminate between viral and bacterial pediatric uncomplicated pneumonia, both of which are common. Some have suggested that assessment of pneumococcal carriage could be used to identify those children with bacterial pneumonia. The...
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-021-06235-z |
| _version_ | 1818779253702918144 |
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| author | Jeffrey M. Pernica Kristin Inch Haifa Alfaraidi Ania Van Meer Redjana Carciumaru Kathy Luinstra Marek Smieja |
| author_facet | Jeffrey M. Pernica Kristin Inch Haifa Alfaraidi Ania Van Meer Redjana Carciumaru Kathy Luinstra Marek Smieja |
| author_sort | Jeffrey M. Pernica |
| collection | DOAJ |
| description | Abstract Background Readily-available diagnostics do not reliably discriminate between viral and bacterial pediatric uncomplicated pneumonia, both of which are common. Some have suggested that assessment of pneumococcal carriage could be used to identify those children with bacterial pneumonia. The objective of this study was to determine if nasopharyngeal pneumococcal colonization patterns differed between children with definite viral disease, definite bacterial disease, and respiratory disease of indeterminate etiology. Methods Three groups of subjects were recruited: children with critical respiratory illness, previously healthy children with respiratory illness admitted to the ward, and previously healthy children diagnosed in the emergency department with non-severe pneumonia. Subjects were categorized as follows: a) viral infection syndrome (eg. bronchiolitis), b) bacterial infection syndrome (ie. pneumonia complicated by effusion/empyema), or c) ‘indeterminate’ pneumonia. Subjects’ nasopharyngeal swabs underwent quantitative PCR testing for S. pneumoniae. Associations between categorical variables were determined with Fisher’s exact, chi-square, or logistic regression, as appropriate. Associations between quantitative genomic load and categorical variables was determined by linear regression. Results There were 206 children in Group 1, 122 children in Group 2, and 179 children in Group 3. Only a minority (227/507, 45%) had detectable pneumococcal carriage; in those subjects, there was no association of quantitative genomic load with age, recruitment group, or disease category. In multivariate logistic regression, pneumococcal colonization > 3 log copies/mL was associated with younger age and recruitment group, but not with disease category. Conclusions The nasopharyngeal S. pneumoniae colonization patterns of subjects with definite viral infection were very similar to colonization patterns of those with definite bacterial infection or indeterminate pneumonia. Assessment and quantification of nasopharyngeal pneumococcal colonization does not therefore appear useful to discriminate between acute viral and bacterial respiratory disease; consequently, this diagnostic testing is unlikely to reliably determine which children with indeterminate pneumonia have a bacterial etiology and/or require antibiotic treatment. |
| first_indexed | 2024-12-18T11:57:41Z |
| format | Article |
| id | doaj.art-b881e97cff5a4124a8384498337276b7 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-18T11:57:41Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-b881e97cff5a4124a8384498337276b72022-12-21T21:09:00ZengBMCBMC Infectious Diseases1471-23342021-05-012111710.1186/s12879-021-06235-zAssessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional studyJeffrey M. Pernica0Kristin Inch1Haifa Alfaraidi2Ania Van Meer3Redjana Carciumaru4Kathy Luinstra5Marek Smieja6Department of Pediatrics, McMaster UniversityDepartment of Pediatrics, McMaster UniversityDepartment of Pediatrics, McMaster UniversityDepartment of Pediatrics, McMaster UniversityDepartment of Pediatrics, McMaster UniversityDepartment of Laboratory Medicine, St. Joseph’s Healthcare HamiltonDepartment of Laboratory Medicine, St. Joseph’s Healthcare HamiltonAbstract Background Readily-available diagnostics do not reliably discriminate between viral and bacterial pediatric uncomplicated pneumonia, both of which are common. Some have suggested that assessment of pneumococcal carriage could be used to identify those children with bacterial pneumonia. The objective of this study was to determine if nasopharyngeal pneumococcal colonization patterns differed between children with definite viral disease, definite bacterial disease, and respiratory disease of indeterminate etiology. Methods Three groups of subjects were recruited: children with critical respiratory illness, previously healthy children with respiratory illness admitted to the ward, and previously healthy children diagnosed in the emergency department with non-severe pneumonia. Subjects were categorized as follows: a) viral infection syndrome (eg. bronchiolitis), b) bacterial infection syndrome (ie. pneumonia complicated by effusion/empyema), or c) ‘indeterminate’ pneumonia. Subjects’ nasopharyngeal swabs underwent quantitative PCR testing for S. pneumoniae. Associations between categorical variables were determined with Fisher’s exact, chi-square, or logistic regression, as appropriate. Associations between quantitative genomic load and categorical variables was determined by linear regression. Results There were 206 children in Group 1, 122 children in Group 2, and 179 children in Group 3. Only a minority (227/507, 45%) had detectable pneumococcal carriage; in those subjects, there was no association of quantitative genomic load with age, recruitment group, or disease category. In multivariate logistic regression, pneumococcal colonization > 3 log copies/mL was associated with younger age and recruitment group, but not with disease category. Conclusions The nasopharyngeal S. pneumoniae colonization patterns of subjects with definite viral infection were very similar to colonization patterns of those with definite bacterial infection or indeterminate pneumonia. Assessment and quantification of nasopharyngeal pneumococcal colonization does not therefore appear useful to discriminate between acute viral and bacterial respiratory disease; consequently, this diagnostic testing is unlikely to reliably determine which children with indeterminate pneumonia have a bacterial etiology and/or require antibiotic treatment.https://doi.org/10.1186/s12879-021-06235-zDiagnostic microbiologyPneumoniaRespiratory tract infectionEpidemiologyStreptococcus pneumoniae |
| spellingShingle | Jeffrey M. Pernica Kristin Inch Haifa Alfaraidi Ania Van Meer Redjana Carciumaru Kathy Luinstra Marek Smieja Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study BMC Infectious Diseases Diagnostic microbiology Pneumonia Respiratory tract infection Epidemiology Streptococcus pneumoniae |
| title | Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study |
| title_full | Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study |
| title_fullStr | Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study |
| title_full_unstemmed | Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study |
| title_short | Assessment of nasopharyngeal Streptococcus pneumoniae colonization does not permit discrimination between Canadian children with viral and bacterial respiratory infection: a matched-cohort cross-sectional study |
| title_sort | assessment of nasopharyngeal streptococcus pneumoniae colonization does not permit discrimination between canadian children with viral and bacterial respiratory infection a matched cohort cross sectional study |
| topic | Diagnostic microbiology Pneumonia Respiratory tract infection Epidemiology Streptococcus pneumoniae |
| url | https://doi.org/10.1186/s12879-021-06235-z |
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