Abstract
AIMS—To audit the management of community acquired pneumonia before and after the introduction of a protocol. To determine the aetiology of pneumonia using routine investigations and polymerase chain reaction (PCR). METHODS—Retrospective and prospective audit following the introduction of a management protocol. Prospective cases were investigated routinely and with PCR on blood and nasopharyngeal aspirate. RESULTS—There was a significant increase in rational prescribing following introduction of the protocol with 75% of children receiving intravenous penicillin or erythromycin compared with 26% beforehand. Of 89 children in the prospective group, 51 microbiological diagnoses were achieved in 48 children. Seven children had Streptococcus pneumoniae infection, 14 had Mycoplasma infection, six had pertussis, and one had Chlamydia pneumoniae infection. Twenty three children had a viral cause of which respiratory syncytial virus was commonest. CONCLUSIONS—Introduction of the protocol led to improved prescribing. PCR increased the diagnostic yield and the results support the management protocol.
Full Text
The Full Text of this article is available as a PDF (107.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson G., Esmonde T. S., Coles S., Macklin J., Carnegie C. A comparative safety and efficacy study of clarithromycin and erythromycin stearate in community-acquired pneumonia. J Antimicrob Chemother. 1991 Feb;27 (Suppl A):117–124. doi: 10.1093/jac/27.suppl_a.117. [DOI] [PubMed] [Google Scholar]
- Cadieux N., Lebel P., Brousseau R. Use of a triplex polymerase chain reaction for the detection and differentiation of Mycoplasma pneumoniae and Mycoplasma genitalium in the presence of human DNA. J Gen Microbiol. 1993 Oct;139(10):2431–2437. doi: 10.1099/00221287-139-10-2431. [DOI] [PubMed] [Google Scholar]
- Carbon C., Bax R. P. Regulating the use of antibiotics in the community. BMJ. 1998 Sep 5;317(7159):663–665. doi: 10.1136/bmj.317.7159.663. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Claesson B. A., Trollfors B., Brolin I., Granström M., Henrichsen J., Jodal U., Juto P., Kallings I., Kanclerski K., Lagergård T. Etiology of community-acquired pneumonia in children based on antibody responses to bacterial and viral antigens. Pediatr Infect Dis J. 1989 Dec;8(12):856–862. doi: 10.1097/00006454-198912000-00006. [DOI] [PubMed] [Google Scholar]
- Clyde W. A., Jr Clinical overview of typical Mycoplasma pneumoniae infections. Clin Infect Dis. 1993 Aug;17 (Suppl 1):S32–S36. [PubMed] [Google Scholar]
- Davey P. G., Bax R. P., Newey J., Reeves D., Rutherford D., Slack R., Warren R. E., Watt B., Wilson J. Growth in the use of antibiotics in the community in England and Scotland in 1980-93. BMJ. 1996 Mar 9;312(7031):613–613. doi: 10.1136/bmj.312.7031.613. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Foy H. M. Infections caused by Mycoplasma pneumoniae and possible carrier state in different populations of patients. Clin Infect Dis. 1993 Aug;17 (Suppl 1):S37–S46. doi: 10.1093/clinids/17.supplement_1.s37. [DOI] [PubMed] [Google Scholar]
- Gabriel A. S., Gnarpe H., Gnarpe J., Hallander H., Nyquist O., Martinsson A. The prevalence of chronic Chlamydia pneumoniae infection as detected by polymerase chain reaction in pharyngeal samples from patients with ischaemic heart disease. Eur Heart J. 1998 Sep;19(9):1321–1327. doi: 10.1053/euhj.1998.1010. [DOI] [PubMed] [Google Scholar]
- Gaydos C. A., Eiden J. J., Oldach D., Mundy L. M., Auwaerter P., Warner M. L., Vance E., Burton A. A., Quinn T. C. Diagnosis of Chlamydia pneumoniae infection in patients with community-acquired pneumonia by polymerase chain reaction enzyme immunoassay. Clin Infect Dis. 1994 Jul;19(1):157–160. doi: 10.1093/clinids/19.1.157. [DOI] [PubMed] [Google Scholar]
- George R. C., Johnson A. P., Speller D. C., Efstratiou A., Broughton K., Patel B. C. Serogroups/types and antibiotic resistance of referred isolates of Streptococcus pneumoniae: 1993 to 1995. Commun Dis Rep CDR Rev. 1997 Oct 17;7(11):R159–R164. [PubMed] [Google Scholar]
- Gnarpe J., Lundbäck A., Sundelöf B., Gnarpe H. Prevalence of Mycoplasma pneumoniae in subjectively healthy individuals. Scand J Infect Dis. 1992;24(2):161–164. doi: 10.3109/00365549209052607. [DOI] [PubMed] [Google Scholar]
- Goossens H., Sprenger M. J. Community acquired infections and bacterial resistance. BMJ. 1998 Sep 5;317(7159):654–657. doi: 10.1136/bmj.317.7159.654. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hargreaves R. M., Slack M. P., Howard A. J., Anderson E., Ramsay M. E. Changing patterns of invasive Haemophilus influenzae disease in England and Wales after introduction of the Hib vaccination programme. BMJ. 1996 Jan 20;312(7024):160–161. doi: 10.1136/bmj.312.7024.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hawkey P. M. The origins and molecular basis of antibiotic resistance. BMJ. 1998 Sep 5;317(7159):657–660. doi: 10.1136/bmj.317.7159.657. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hietala J., Uhari M., Tuokko H., Leinonen M. Mixed bacterial and viral infections are common in children. Pediatr Infect Dis J. 1989 Oct;8(10):683–686. doi: 10.1097/00006454-198910000-00004. [DOI] [PubMed] [Google Scholar]
- Isaacs D. Problems in determining the etiology of community-acquired childhood pneumonia. Pediatr Infect Dis J. 1989 Mar;8(3):143–148. [PubMed] [Google Scholar]
- Jalal H., Organji S., Reynolds J., Bennett D., O'Mason E., Jr, Millar M. R. Determination of penicillin susceptibility of Streptococcus pneumoniae using the polymerase chain reaction. Mol Pathol. 1997 Feb;50(1):45–50. doi: 10.1136/mp.50.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnson A. P., Speller D. C., George R. C., Warner M., Domingue G., Efstratiou A. Prevalence of antibiotic resistance and serotypes in pneumococci in England and Wales: results of observational surveys in 1990 and 1995. BMJ. 1996 Jun 8;312(7044):1454–1456. doi: 10.1136/bmj.312.7044.1454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kaltenboeck B., Kousoulas K. G., Storz J. Two-step polymerase chain reactions and restriction endonuclease analyses detect and differentiate ompA DNA of Chlamydia spp. J Clin Microbiol. 1992 May;30(5):1098–1104. doi: 10.1128/jcm.30.5.1098-1104.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Korppi M., Heiskanen-Kosma T., Jalonen E., Saikku P., Leinonen M., Halonen P., Mäkela P. H. Aetiology of community-acquired pneumonia in children treated in hospital. Eur J Pediatr. 1993 Jan;152(1):24–30. doi: 10.1007/BF02072512. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mastrantonio P., Stefanelli P., Giuliano M. Polymerase chain reaction for the detection of Bordetella pertussis in clinical nasopharyngeal aspirates. J Med Microbiol. 1996 Apr;44(4):261–266. doi: 10.1099/00222615-44-4-261. [DOI] [PubMed] [Google Scholar]
- Nohynek H., Eskola J., Laine E., Halonen P., Ruutu P., Saikku P., Kleemola M., Leinonen M. The causes of hospital-treated acute lower respiratory tract infection in children. Am J Dis Child. 1991 Jun;145(6):618–622. doi: 10.1001/archpedi.1991.02160060036016. [DOI] [PubMed] [Google Scholar]
- O'Neill K. P., Lloyd-Evans N., Campbell H., Forgie I. M., Sabally S., Greenwood B. M. Latex agglutination test for diagnosing pneumococcal pneumonia in children in developing countries. BMJ. 1989 Apr 22;298(6680):1061–1064. doi: 10.1136/bmj.298.6680.1061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ortqvist A. Antibiotic treatment of community-acquired pneumonia in clinical practice: a European perspective. J Antimicrob Chemother. 1995 Jan;35(1):205–212. doi: 10.1093/jac/35.1.205. [DOI] [PubMed] [Google Scholar]
- Rudolph K. M., Parkinson A. J., Black C. M., Mayer L. W. Evaluation of polymerase chain reaction for diagnosis of pneumococcal pneumonia. J Clin Microbiol. 1993 Oct;31(10):2661–2666. doi: 10.1128/jcm.31.10.2661-2666.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rusconi F., Rancilio L., Assael B. M., Bonora G., Cerri M., Pietrogrande M. C., Razon S., Serafini L., Torti G., Vaggi D. Counterimmunoelectrophoresis and latex particle agglutination in the etiologic diagnosis of presumed bacterial pneumonia in pediatric patients. Pediatr Infect Dis J. 1988 Nov;7(11):781–785. doi: 10.1097/00006454-198811000-00007. [DOI] [PubMed] [Google Scholar]
- Salo P., Ortqvist A., Leinonen M. Diagnosis of bacteremic pneumococcal pneumonia by amplification of pneumolysin gene fragment in serum. J Infect Dis. 1995 Feb;171(2):479–482. doi: 10.1093/infdis/171.2.479. [DOI] [PubMed] [Google Scholar]
- Schluger N. W., Rom W. N. The polymerase chain reaction in the diagnosis and evaluation of pulmonary infections. Am J Respir Crit Care Med. 1995 Jul;152(1):11–16. doi: 10.1164/ajrccm.152.1.7599808. [DOI] [PubMed] [Google Scholar]
- Silverman M., Stratton D., Diallo A., Egler L. J. Diagnosis of acute bacterial pneumonia in Nigerian children. Value of needle aspiration of lung of countercurrent immunoelectrophoresis. Arch Dis Child. 1977 Dec;52(12):925–931. doi: 10.1136/adc.52.12.925. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tong C. Y., Donnelly C., Harvey G., Sillis M. Multiplex polymerase chain reaction for the simultaneous detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Chlamydia psittaci in respiratory samples. J Clin Pathol. 1999 Apr;52(4):257–263. doi: 10.1136/jcp.52.4.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tong C. Y., Sillis M. Detection of Chlamydia pneumoniae and Chlamydia psittaci in sputum samples by PCR. J Clin Pathol. 1993 Apr;46(4):313–317. doi: 10.1136/jcp.46.4.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ubukata K., Asahi Y., Yamane A., Konno M. Combinational detection of autolysin and penicillin-binding protein 2B genes of Streptococcus pneumoniae by PCR. J Clin Microbiol. 1996 Mar;34(3):592–596. doi: 10.1128/jcm.34.3.592-596.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wise R., Hart T., Cars O., Streulens M., Helmuth R., Huovinen P., Sprenger M. Antimicrobial resistance. Is a major threat to public health. BMJ. 1998 Sep 5;317(7159):609–610. doi: 10.1136/bmj.317.7159.609. [DOI] [PMC free article] [PubMed] [Google Scholar]