Project Details

On target, On time: improved diagnostics for childhood complicated pneumonia in Asia

Catherine Satzke, PhD

Summary

BACKGROUND: Pneumonia is the leading killer of children worldwide. Empyema (a condition where fluid collects in the pleural cavity surrounding the lungs) affects around 5 per cent of children hospitalized with pneumonia. Treatment requires intravenous and oral antibiotics and drainage of the infected pleural fluid. GAP: The current diagnostic method of culturing the pleural fluid often fails to identify the infecting bacteria, so the microbiological cause remains unknown in most children. As a result, these children are treated for over four weeks with broad spectrum antibiotics to cover all potential bacterial causes, which increases adverse drug reactions and promotes antibiotic resistance circulation in the community. HYPOTHESIS: Molecular techniques that detect bacterial DNA (such as PCR, short for polymerase chain reaction), are highly sensitive but are not routinely employed in clinical laboratories including in Asia. We hypothesize that the proportion of children with empyema with a causative bacterial species detected will be higher by molecular techniques than by culture. If proven, this could enable targeted antibiotic therapy to reach more children earlier, improve patient outcomes and promote the responsible use of antimicrobials which would benefit patients and the community. METHODS: We have recently developed a low-cost and effective molecular test that detects the DNA of the most common causes of pediatric empyema, which outperforms culture by five-fold and has the potential to reduce untargeted antibiotic therapy duration by around 20 days. We will assess the performance of our test by conducting a multicenter prospective study of 400 children under 18 years old who have been hospitalized with empyema in major hospitals in Thailand, the Philippines and Indonesia. Our study aims to provide the necessary evidence for implementing our molecular test as part of standard diagnosis for children with empyema in our sites in Asia, and globally in the future. RESULTS: Pending IMPACT: Our project will bring the benefits of molecular diagnostics to those who need it most and improve patient care and antibiotic stewardship in Asia and around the world. Website Link: https://www.mcri.edu.au/