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.

中文翻译：

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肺炎链球菌胸腔积液聚合酶链反应检测对儿童复杂性肺炎的临床影响


背景 虽然肺炎链球菌 （Spn） 是小儿复杂性社区获得性肺炎 （cCAP） 的主要原因，但很少通过基于培养的方法恢复。我们研究了 Spn 聚合酶链反应 （PCR） 测定对胸腔积液的真实临床影响。方法 这项前后准实验队列研究比较了 2016 年至 2023 年间在科罗拉多州儿童医院因需要胸腔积液或脓胸引流而住院的 cCAP 儿童的病原体检测、抗生素使用和结果。在 2 个诊断期对患者进行比较： Spn PCR 前和 Spn PCR 后。Cox 比例风险模型比较了从入院到病原体检测、最佳治疗（最狭窄的病原体导向或指南推荐的经验性治疗）和耐甲氧西林金黄色葡萄球菌 （MRSA） 治疗停止的时间。结果 与 Spn 前 PCR 队列 （n = 149） 相比，Spn PCR 后队列 （n = 79） 更有可能检测到病原体 （PCR 后 73.4% vs PCR 前 38.9%，P < .001），由更多的 Spn 检测驱动 （45.6% vs 14.1%，P < .001）。在 Spn PCR 后期间，住院期间检测到病原体的时间较短 （P < .001）。PCR 后队列更有可能接受最佳治疗 （84.8% vs 53.0%，P < .001），最佳抗生素的中位时间更短 （4.9 天 vs 10.0 天，P < .001） 和 MRSA 治疗停止 （1.5 天 vs 2.5 天，P = .03）。住院时间或再入院率没有差异。 结论 cCAP 患儿胸腔积液 Spn 分子检测导致微生物学诊断显著增加，并且与抗生素优化和减少 MRSA 治疗暴露相关，表明其对儿科复杂性肺炎的临床影响。