Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study
<h4>Background</h4> <p>Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited. Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this po...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Formato: | Journal article |
| Idioma: | English |
| Publicado em: |
Oxford University Press
2017
|
| _version_ | 1826291772086550528 |
|---|---|
| author | Baggett, HC Watson, NL Knoll, M Brooks, WA Feikin, DR Hammitt, LL Howie, SRC Kotloff, KL Levine, OS Madhi, SA Murdoch, DR Scott, JAG Thea, DM Antonio, M Awori, JO Baillie, VL DeLuca, AN Driscoll, AJ Duncan, J Ebruke, BE Goswami, D Higdon, MM Karron, RA Moore, DP Morpeth, SC Mulindwa, JM Park, DE Paveenkittiporn, W Piralam, B Prosperi, C Sow, SO Tapia, MD Zaman, K Zeger, SL O'Brien, KL |
| author_facet | Baggett, HC Watson, NL Knoll, M Brooks, WA Feikin, DR Hammitt, LL Howie, SRC Kotloff, KL Levine, OS Madhi, SA Murdoch, DR Scott, JAG Thea, DM Antonio, M Awori, JO Baillie, VL DeLuca, AN Driscoll, AJ Duncan, J Ebruke, BE Goswami, D Higdon, MM Karron, RA Moore, DP Morpeth, SC Mulindwa, JM Park, DE Paveenkittiporn, W Piralam, B Prosperi, C Sow, SO Tapia, MD Zaman, K Zeger, SL O'Brien, KL |
| author_sort | Baggett, HC |
| collection | OXFORD |
| description | <h4>Background</h4> <p>Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited. Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this potential association.</p> <h4>Methods</h4> <p>PERCH is a case-control study in 7 countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. Cases were children aged 1–59 months hospitalized with World Health Organization–defined severe or very severe pneumonia. Controls were randomly selected from the community. Microbiologically confirmed pneumococcal pneumonia (MCPP) was confirmed by detection of pneumococcus in a relevant normally sterile body fluid. Colonization density was calculated with quantitative polymerase chain reaction analysis of nasopharyngeal/oropharyngeal specimens.</p> <h4>Results</h4> <p>Median colonization density among 56 cases with MCPP (MCPP cases; 17.28 × 106 copies/mL) exceeded that of cases without MCPP (non-MCPP cases; 0.75 × 10^6) and controls (0.60 × 10^6) (each P < .001). The optimal density for discriminating MCPP cases from controls using the Youden index was >6.9 log10 copies/mL; overall, the sensitivity was 64% and the specificity 92%, with variable performance by site. The threshold was lower (≥4.4 log10 copies/mL) when MCPP cases were distinguished from controls who received antibiotics before specimen collection. Among the 4035 non-MCPP cases, 500 (12%) had pneumococcal colonization density >6.9 log10 copies/mL; above this cutoff was associated with alveolar consolidation at chest radiography, very severe pneumonia, oxygen saturation <92%, C-reactive protein ≥40 mg/L, and lack of antibiotic pretreatment (all P < .001).</p> <h4>Conclusions</h4> <p>Pneumococcal colonization density >6.9 log10 copies/mL was strongly associated with MCPP and could be used to improve estimates of pneumococcal pneumonia prevalence in childhood pneumonia studies. Our findings do not support its use for individual diagnosis in a clinical setting.</p> |
| first_indexed | 2024-03-07T03:04:28Z |
| format | Journal article |
| id | oxford-uuid:b206dc9b-3390-4e1e-a131-5c3d456250f3 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:04:28Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:b206dc9b-3390-4e1e-a131-5c3d456250f32022-03-27T04:08:53ZDensity of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b206dc9b-3390-4e1e-a131-5c3d456250f3EnglishSymplectic Elements at OxfordOxford University Press2017Baggett, HCWatson, NLKnoll, MBrooks, WAFeikin, DRHammitt, LLHowie, SRCKotloff, KLLevine, OSMadhi, SAMurdoch, DRScott, JAGThea, DMAntonio, MAwori, JOBaillie, VLDeLuca, ANDriscoll, AJDuncan, JEbruke, BEGoswami, DHigdon, MMKarron, RAMoore, DPMorpeth, SCMulindwa, JMPark, DEPaveenkittiporn, WPiralam, BProsperi, CSow, SOTapia, MDZaman, KZeger, SLO'Brien, KL <h4>Background</h4> <p>Previous studies suggested an association between upper airway pneumococcal colonization density and pneumococcal pneumonia, but data in children are limited. Using data from the Pneumonia Etiology Research for Child Health (PERCH) study, we assessed this potential association.</p> <h4>Methods</h4> <p>PERCH is a case-control study in 7 countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. Cases were children aged 1–59 months hospitalized with World Health Organization–defined severe or very severe pneumonia. Controls were randomly selected from the community. Microbiologically confirmed pneumococcal pneumonia (MCPP) was confirmed by detection of pneumococcus in a relevant normally sterile body fluid. Colonization density was calculated with quantitative polymerase chain reaction analysis of nasopharyngeal/oropharyngeal specimens.</p> <h4>Results</h4> <p>Median colonization density among 56 cases with MCPP (MCPP cases; 17.28 × 106 copies/mL) exceeded that of cases without MCPP (non-MCPP cases; 0.75 × 10^6) and controls (0.60 × 10^6) (each P < .001). The optimal density for discriminating MCPP cases from controls using the Youden index was >6.9 log10 copies/mL; overall, the sensitivity was 64% and the specificity 92%, with variable performance by site. The threshold was lower (≥4.4 log10 copies/mL) when MCPP cases were distinguished from controls who received antibiotics before specimen collection. Among the 4035 non-MCPP cases, 500 (12%) had pneumococcal colonization density >6.9 log10 copies/mL; above this cutoff was associated with alveolar consolidation at chest radiography, very severe pneumonia, oxygen saturation <92%, C-reactive protein ≥40 mg/L, and lack of antibiotic pretreatment (all P < .001).</p> <h4>Conclusions</h4> <p>Pneumococcal colonization density >6.9 log10 copies/mL was strongly associated with MCPP and could be used to improve estimates of pneumococcal pneumonia prevalence in childhood pneumonia studies. Our findings do not support its use for individual diagnosis in a clinical setting.</p> |
| spellingShingle | Baggett, HC Watson, NL Knoll, M Brooks, WA Feikin, DR Hammitt, LL Howie, SRC Kotloff, KL Levine, OS Madhi, SA Murdoch, DR Scott, JAG Thea, DM Antonio, M Awori, JO Baillie, VL DeLuca, AN Driscoll, AJ Duncan, J Ebruke, BE Goswami, D Higdon, MM Karron, RA Moore, DP Morpeth, SC Mulindwa, JM Park, DE Paveenkittiporn, W Piralam, B Prosperi, C Sow, SO Tapia, MD Zaman, K Zeger, SL O'Brien, KL Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title | Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title_full | Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title_fullStr | Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title_full_unstemmed | Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title_short | Density of upper respiratory colonization with Streptococcus pneumoniae and Its role in the diagnosis of pneumococcal pneumonia among children aged <5 5 years in the PERCH study |
| title_sort | density of upper respiratory colonization with streptococcus pneumoniae and its role in the diagnosis of pneumococcal pneumonia among children aged lt 5 5 years in the perch study |
| work_keys_str_mv | AT baggetthc densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT watsonnl densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT knollm densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT brookswa densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT feikindr densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT hammittll densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT howiesrc densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT kotloffkl densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT levineos densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT madhisa densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT murdochdr densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT scottjag densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT theadm densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT antoniom densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT aworijo densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT baillievl densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT delucaan densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT driscollaj densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT duncanj densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT ebrukebe densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT goswamid densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT higdonmm densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT karronra densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT mooredp densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT morpethsc densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT mulindwajm densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT parkde densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT paveenkittipornw densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT piralamb densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT prosperic densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT sowso densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT tapiamd densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT zamank densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT zegersl densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy AT obrienkl densityofupperrespiratorycolonizationwithstreptococcuspneumoniaeanditsroleinthediagnosisofpneumococcalpneumoniaamongchildrenagedlt55yearsintheperchstudy |