Parapneumonic Empyema Complicating Community-acquired Pneumonia: Etiology in the Era of Pneumococcal Vaccination and Role of Molecular Diagnosis

Authors

• Antonio C Arrieta
• Stephanie Osborne
• Lindsay R Grant
• Bradford D Gessner
• Anne J Blaschke
• Kristina G Hulten
• Delma J Nieves
• Ashley Miller
• Cody Bender
• Raul Isturiz
• Ronika Alexander
• Shannon M Nielsen
• Linda B Lamberth
• Alejandro Cane
• Adriano Arguedas

Language

English

Publication Date

4-21-2025

Journal

Journal of the Pediatric Infectious Diseases Society

DOI

10.1097/INF.0000000000004833

PMID

40257269

PMCID

PMC12150791

PubMedCentral® Posted Date

4-21-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Impact of pneumococcal conjugate vaccines (PCVs) on pneumococcal disease is well described; pneumococcus is infrequently identified by culture in pneumonia. Yield is higher when pleural fluid is cultured. Polymerase chain reaction (PCR) in pleural fluid samples improves pathogen identification, particularly in the case of S. pneumoniae.

Methods: Healthy children with empyema who underwent pleural fluid drainage were eligible. Demographics and PCV immunization status were collected. Blood/pleural fluid cultures were obtained. Pleural fluid samples were sent for PCR for pathogen. Serotyping was done by Neufeld-Quellung reaction on pneumococcus isolates, and PCR in culture negative cases.

Results: From December 2018 to September 2023, 74 patients were enrolled. Pathogens were cultured in 22 patients (29.7%), with pneumococcus found in 6 (27.3%). PCR identified additional pathogens in 23 patients (31.1%), including 18 pneumococci (81.8%) and real-time PCR identified 5 more pneumococci, totaling 29 pneumococci, with 23 (79.3%) detected by PCR only. Serotype information was available for 27 (93.1%) pneumococci; 22 (81.5%) were identified as PCV-13 serotypes, with serotype 3 being present in 17 (63%) cases. Among patients with a PCV-13 serotype detected through culture or molecular methods, 15 (68.2%) were fully vaccinated with PCV-13, including 11 of 17 (65%) with serotype 3.

Conclusion: S. pneumoniae , particularly serotype 3, is the leading bacterial pathogen in children ≤18 years old. Molecular diagnosis enhances pathogen detection. Ongoing surveillance is crucial to monitor etiology changes as new pneumococcal vaccines are introduced.

Keywords

Humans, Community-Acquired Infections, Streptococcus pneumoniae, Male, Female, Child, Preschool, Pneumococcal Vaccines, Pneumonia, Pneumococcal, Infant, Child, Empyema, Pleural, Adolescent, Empyema, Serogroup, Vaccination, Community-Acquired Pneumonia, empyema, community-acquired pneumonia, PCV, pneumococcal vaccination, Streptococcus pneumoniae

Published Open-Access

yes

Recommended Citation

Arrieta, Antonio C; Osborne, Stephanie; Grant, Lindsay R; et al., "Parapneumonic Empyema Complicating Community-acquired Pneumonia: Etiology in the Era of Pneumococcal Vaccination and Role of Molecular Diagnosis" (2025). Faculty, Staff and Students Publications. 7668.
https://digitalcommons.library.tmc.edu/baylor_docs/7668