Colonization Density of the Upper Respiratory Tract as a Predictor of Pneumonia-Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii.

Authors

Daniel E Park, George Washington University
Henry C Baggett
Stephen R C Howie
Qiyuan Shi
Nora L Watson
W Abdullah Brooks
PERCH Study Group

Document Type

Journal Article

Publication Date

6-15-2017

Journal

Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America

Volume

64

Issue

suppl. 3

Inclusive Pages

S328-336

DOI

10.1093/cid/cix104

Abstract

Background.

There is limited information on the association between colonization density of upper respiratory tract colonizers and pathogen-specific pneumonia. We assessed this association for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. Methods.

In 7 low- and middle-income countries, nasopharyngeal/oropharyngeal swabs from children with severe pneumonia and age-frequency matched community controls were tested using quantitative polymerase chain reaction (PCR). Differences in median colonization density were evaluated using the Wilcoxon rank-sum test. Density cutoffs were determined using receiver operating characteristic curves. Cases with a pathogen identified from lung aspirate culture or PCR, pleural fluid culture or PCR, blood culture, and immunofluorescence for P. jirovecii defined microbiologically confirmed cases for the given pathogens. Results.

Higher densities of H. influenzae were observed in both microbiologically confirmed cases and chest radiograph (CXR)–positive cases compared to controls. Staphylococcus aureus and P. jirovecii had higher densities in CXR-positive cases vs controls. A 5.9 log₁₀ copies/mL density cutoff for H. influenzae yielded 86% sensitivity and 77% specificity for detecting microbiologically confirmed cases; however, densities overlapped between cases and controls and positive predictive values were poor (<3%). Informative density cutoffs were not found for S. aureus and M. catarrhalis, and a lack of confirmed case data limited the cutoff identification for P. jirovecii. Conclusions.

There is evidence for an association between H. influenzaecolonization density and H. influenzae–confirmed pneumonia in children; the association may be particularly informative in epidemiologic studies. Colonization densities of M. catarrhalis, S. aureus, and P. jirovecii are unlikely to be of diagnostic value in clinical settings.

Comments

Reproduced with permission of Oxford University Press. Clinical Infectious Diseases

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

APA Citation

Park, D., Baggett, H., Howie, S., Shi, Q., Watson, N., Brooks, W., & PERCH Study Group (2017). Colonization Density of the Upper Respiratory Tract as a Predictor of Pneumonia-Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii.. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America, 64 (suppl. 3). http://dx.doi.org/10.1093/cid/cix104

Peer Reviewed

1

Open Access

1