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. 2024 Dec 17;79(6):1487-1494.
doi: 10.1093/cid/ciae439.

Clinical Impact of Pleural Fluid Streptococcus pneumoniae Polymerase Chain Reaction Testing in Children With Complicated Pneumonia

Erin C Ho  1   2 , Kaitlin E Olson  1 , Molly Butler  3 , Meghan Birkholz  2 , Kristen Miller  1 , Christine E MacBrayne  4 , Sarah Jung  3 , Kevin Messacar  1   2 , Edwin J Asturias  1   2 , Samuel R Dominguez  1   2   3
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Clinical Impact of Pleural Fluid Streptococcus pneumoniae Polymerase Chain Reaction Testing in Children With Complicated Pneumonia

Erin C Ho et al. Clin Infect Dis. .

Abstract

Background: While Streptococcus pneumoniae (Spn) is the leading cause of pediatric complicated community-acquired pneumonia (cCAP), it is infrequently recovered by culture-based methods. We studied the real-world clinical impact of an Spn polymerase chain reaction (PCR) assay for pleural fluid.

Methods: This pre-post quasi-experimental cohort study compared pathogen detection, antibiotic usage, and outcomes in children hospitalized with cCAP requiring pleural effusion or empyema drainage at Children's Hospital Colorado between 2016 and 2023. Patients were compared across 2 diagnostic periods: pre-Spn PCR and post-Spn PCR. Cox proportional hazard models compared time from admission to pathogen detection, optimal therapy (narrowest pathogen-directed or guideline-recommended empiric therapy), and methicillin-resistant Staphylococcus aureus (MRSA) therapy discontinuation between periods.

Results: Compared to the pre-Spn PCR cohort (n = 149), the post-Spn PCR cohort (n = 79) was more likely to have a pathogen detected (73.4% post-PCR vs 38.9% pre-PCR, P < .001), driven by more Spn detections (45.6% vs 14.1%, P < .001). Time to pathogen detection during hospitalization was shorter in the post-Spn PCR period (P < .001). The post-PCR cohort was more likely to receive optimal therapy (84.8% vs 53.0%, P < .001), with shorter median times to optimal antibiotics (4.9 vs 10.0 days, P < .001) and MRSA therapy discontinuation (1.5 vs 2.5 days, P = .03). There were no differences in hospital length of stay or readmissions.

Conclusions: Spn molecular testing of pleural fluid in children with cCAP resulted in significantly more microbiologic diagnoses and was associated with the optimization of antibiotics and decreased exposure to MRSA therapy, suggesting its clinical impact for pediatric complicated pneumonia.

Keywords: Streptococcus pneumoniae; PCR; children; complicated pneumonia; pleural fluid.

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Conflict of interest statement

Potential conflicts of interest . S. R. D. receives grants from Biofire Diagnostics, Karius, and Pfizer and serves as a consultant for Biofire Diagnostics, Karius, and DelveBio, outside the submitted work. E. J. A. has received research grant support through his institution from Pfizer. M. B. has received conference attendance support from Pfizer. S. J. is a consultant for Roche Diagnostics and Karius, and has received conference attendance support from Diasorin, Karius, and bioMérieux. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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