This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yang, S.
Right arrow Articles by Rothman, R. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yang, S.
Right arrow Articles by Rothman, R. E.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, July 2005, p. 3221-3226, Vol. 43, No. 7
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.7.3221-3226.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Quantitative PCR Assay Using Sputum Samples for Rapid Diagnosis of Pneumococcal Pneumonia in Adult Emergency Department Patients

Samuel Yang,1 Shin Lin,1 Ambreen Khalil,1 Charlotte Gaydos,2 Eric Nuemberger,2 George Juan,1 Justin Hardick,2 John G. Bartlett,2 Paul G. Auwaerter,2 and Richard E. Rothman1*

Department of Emergency Medicine,1 Department of Medicine, Division of Infectious Disease, Johns Hopkins University, Baltimore, Maryland2

Received 2 December 2004/ Returned for modification 28 December 2004/ Accepted 16 February 2005

Accurate diagnosis of pneumococcal pneumonia in the acute-care setting remains a challenge due to the inadequate sensitivity of conventional diagnostic tests. Sputum cultures, which are likely to have the highest diagnostic yields of all specimen types, have been considered unreliable, due to their inability to differentiate colonization from infection. Our objective was to evaluate the potential clinical utility of a rapid quantitative real-time PCR assay using sputum samples for Streptococcus pneumoniae in adult patients with community-acquired pneumonia (CAP). A prospective clinical observational study of consecutively enrolled emergency department patients with CAP was performed; only those patients with excess good-quality sputum samples were included for evaluation. Sputum samples were tested for the presence of S. pneumoniae by using a quantitative PCR that targets the pneumolysin gene. PCR findings were compared with those of a composite reference standard comprising Gram staining of sputum samples and sputum/blood cultures. The area under the curve (AUC) and a log-transformed threshold, which provides the maximal sensitivity and specificity, were calculated. Of 487 subjects enrolled, 129 were evaluable. Receiver operating characteristic curve analysis demonstrated an AUC of 0.87. Sensitivity and specificity were 90.0 percent and 80.0 percent, respectively; positive and negative predictive values were 58.7 percent and 96.2 percent, respectively. We have demonstrated that a quantitative rapid pneumolysin PCR assay has favorable accuracy for diagnosis of pneumococcal pneumonia in adult patients with CAP; this assay may be a useful diagnostic adjunct for clinicians, particularly those practicing in the acute-care setting, where rapid pathogen identification may assist in selection of the most appropriate antibiotics.

* Corresponding author. Mailing address: Department of Emergency Medicine, 1830 E. Monument St., Suite 6-100, Baltimore, MD 21205. Phone: (410) 614-5933. Fax: (410) 502-8881. E-mail: rrothman{at}jhmi.edu.

Journal of Clinical Microbiology, July 2005, p. 3221-3226, Vol. 43, No. 7
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.7.3221-3226.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Rubin, L. G., Rizvi, A., Baer, A. (2008). Effect of Swab Composition and Use of Swabs versus Swab-Containing Skim Milk-Tryptone-Glucose-Glycerol (STGG) on Culture- or PCR-Based Detection of Streptococcus pneumoniae in Simulated and Clinical Respiratory Specimens in STGG Transport Medium. J. Clin. Microbiol. 46: 2635-2640 [Abstract] [Full Text]  
  • Fukushima, K. Y., Yanagihara, K., Hirakata, Y., Sugahara, K., Morinaga, Y., Kohno, S., Kamihira, S. (2008). Rapid Identification of Penicillin and Macrolide Resistance Genes and Simultaneous Quantification of Streptococcus pneumoniae in Purulent Sputum Samples by Use of a Novel Real-Time Multiplex PCR Assay. J. Clin. Microbiol. 46: 2384-2388 [Abstract] [Full Text]  
  • Yang, S., Ramachandran, P., Hardick, A., Hsieh, Y.-H., Quianzon, C., Kuroki, M., Hardick, J., Kecojevic, A., Abeygunawardena, A., Zenilman, J., Melendez, J., Doshi, V., Gaydos, C., Rothman, R. E. (2008). Rapid PCR-Based Diagnosis of Septic Arthritis by Early Gram-Type Classification and Pathogen Identification. J. Clin. Microbiol. 46: 1386-1390 [Abstract] [Full Text]  
  • del Mar Garcia-Suarez, M., Cima-Cabal, M. D., Villaverde, R., Espinosa, E., Falguera, M., de Los Toyos, J. R., Vazquez, F., Mendez, F. J. (2007). Performance of a Pneumolysin Enzyme-Linked Immunosorbent Assay for Diagnosis of Pneumococcal Infections. J. Clin. Microbiol. 45: 3549-3554 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»