1. The authors mention that "in cases of S.
pneumoniae, K. pneumoniae and S. aureus, all cases
detected by PCR analysis of the respiratory samples were also
detected by culture." Authors have not provided the number or
proportion of cases detected by PCR and culture. The bacterial load
and antibiotic sensitivity of the culture positive cases would have
contributed to the existing knowledge.
2. The use of oropharyngeal aspirate as the
sample for isolation of bacterial pathogens associated with
community acquired pneumonia (CAP) raises many questions. This is
again highlighted by the isolation of organism like Acinetobacter
and Citrobacter species from CAP cases. The value of
isolating bacterial organisms that are frequently detected in the
upper airways of children (eg, Streptococcus pneumoniae,
Haemophilus influenzae, Staphylococcus aureus) are questionable.
Nevertheless, had the authors provided the serotypes of the
pneumococcal isolates, the presence of serotypes that are rarely
found in the upper respiratory tract but are well recognized causes
of invasive disease (eg, serotype 1), may have been highly
predictive of pneumococcal pneumonia [2].
3. There is no mention whether the children had
any pre-existing respiratory morbidity, as chronic respiratory
diseases would significantly influence the bacterial flora.
4. The authors did not mention whether the
children received antibiotics prior to sampling. Stralin, et al.
[3] demonstrated that use of antibiotics decreased the yield of
culture for S. pneumoniae significantly compared to PCR.
5. The conjugate H. influenzae vaccine is
known to decrease the nasopharyngeal carriage of the organism [4],
and many of these children might have received this vaccine as per
latest National Immunization Schedule. As all the H. influenzae
isolates were ‘non type b’, the data on H influenzae immunization
status of the children would have been interesting.
6. Nasopharyngeal carriage of S. pneumoniae
has been used as a surrogate marker for invasive disease in children
with pneumonia [5]. The data on treatment received by the children
and their outcome would have enlightened the readers about the
clinical usefulness of the isolates in the absence of a positive
blood culture.