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Pneumococcal Colonisation Rates in Patients Admitted to a UK Hospital with Lower Respiratory Tract Infection - a prospective case-control study

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Collins, Andrea ORCID: https://orcid.org/0000-0002-4094-1572, Johnstone, Catherine M K, Gritzfeld, Jenna, Banyard, Antonia, Hancock, Carole, Wright, Angela, Macfarlane, Laura, Ferreira, Daniela ORCID: https://orcid.org/0000-0001-7730-9477 and Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116 (2016) 'Pneumococcal Colonisation Rates in Patients Admitted to a UK Hospital with Lower Respiratory Tract Infection - a prospective case-control study'. Journal of clinical microbiology, Vol 54, Issue 4, pp. 944-949.

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Abstract

BACKGROUND
Current diagnostic tests are ineffective at identifying the aetiological pathogen in hospitalised adults with lower respiratory tract infection (LRTI). The association of pneumococcal colonisation with disease has been suggested as a means to increase diagnostic precision. We compared pneumococcal colonisation rate and density of nasal pneumococcal colonisation by a) classical culture and b) quantitative real time lytA Polymerase Chain Reaction (qPCR) in patients admitted to hospital in the UK with LRTI compared to control patients.

METHODS
826 patients were screened for inclusion in this prospective case-control study. 38 patients were recruited, 19 with confirmed LRTI and 19 controls with another diagnosis. Nasal wash (NW) was collected at the time of recruitment.

RESULTS
Pneumococcal colonisation was detected in 1 LRTI patient and 3 controls (p=0.6) by classical culture. Using qPCR pneumococcal colonisation was detected in 10 LRTI patients and 8 controls (p=0.5). Antibiotic usage prior to sampling was significantly higher in the LRTI than control group 19 v. 3 (p<0.001). Using a clinically relevant cut-off of >8000 copies/ml on qPCR pneumococcal colonisation was found in 3 LRTI patients and 4 controls (p > 0.05).

CONCLUSIONS
We conclude that neither prevalence nor density of nasal pneumococcal colonisation (by culture and qPCR) can be used as a method of microbiological diagnosis in hospitalised adults with LRTI in the UK. A community based study recruiting patients prior to antibiotic therapy may be a useful future step.

Item Type: Article
Subjects: WB Practice of Medicine > Diagnosis > General Diagnosis > WB 141 General works
WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 217 Pneumococcal infections
WF Respiratory System > WF 140 Diseases of the respiratory system (General)
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1128/JCM.02008-15
Depositing User: Tracy Seddon
Date Deposited: 17 Feb 2016 15:44
Last Modified: 12 Oct 2018 08:57
URI: http://archive.lstmed.ac.uk/id/eprint/5659

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