| Summary: | Community-acquired pneumonia (CAP) is still a major cause of morbidity and
mortality especially to children and compromised hosts, such as the old and those with
underlying chronic diseases. Knowledge of pathogens causing CAP constitutes the basis for
selection of antimicrobial treatment. Previous data have shown that etiological agents can
be identified in only up to 50% of patients, but this figure can be improved by using polymerase
chain reaction (PCR). This study was designed to evaluate multiplex real-time PCR as a
method for rapid differential detection of five bacterial causes of CAP (Streptococcus
pneumoniae, Burkholderia pseudomallei and atypical bacterial pathogens namely Mycoplasma
pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila) in CAP patients
attending Hospital Tengku Ampuan Afzan (HTAA)/ Kuantan, Pahang, Malaysia. Two previously
developed multiplex real-time PCR assays, duplex for the differential detection of S.
pneumoniae and B. pseudomallei and triplex for the atypical bacterial pathogens, were used
to detect a bacterial cause of CAP in blood and respiratory samples. Thus, 46 blood and 45
respiratory samples collected from 46 adult CAP patients admitted to HTAA were analysed by
multiplex real-time PCR assays and conventional methods. The microbial etiology of CAP
could be established for 39.1% (18/46) of CAP patients by conventional methods and this was
increased to 65.2% (30/46) with the additional use of real-time PCR. The most frequently
detected pathogens were S. pneumoniae (21.7% - all by PCR alone), Klebsiella pneumoniae
(17.3%), B. pseudomallei (13% - 83% of them positive by PCR alone and 17% by both culture
and PCR), Pseudomonas aeruginosa (6.5%), M. pneumoniae (6.5% - all by serology), C.
pneumoniae (4.3% - all positive by both PCR and serology), L. pneumophila (2.1% - all by PCR
alone), Escherichia coli (4.3%). Haemophilus infuenzae, Acinetobacter lwoffii and
Acinetobacter baumannii were detected by conventional methods (2.1% for each).
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