2135. Streptococcus pneumoniae DNA (lytA) Detection in Clinical Samples Sent for a Respiratory Viral Polymerase Chain Reaction: Is There Bacterial-Viral Association?

Background Streptococcus pneumoniae (SPNEU) is a major cause of community-acquired pneumonia and frequently complicates respiratory viral infections. Clinical differentiation of viral and bacterial respiratory tract infection can be difficult, as can predicting which patients with respiratory viral infection will develop bacterial infection. A SPNEU polymerase chain reaction (PCR) to specific DNA region lytA may be able to determine which patients with viral infections may develop bacterial infection. Methods Stored nucleic acid extracts from clinical samples collected and tested for respiratory viral PCR (RVP) in 2015 and 2016 were tested for SPNEU lytA DNA using standard laboratory procedure. Analyses of demographic data, RVP and SPNEU PCR result were performed to determine relevant associations. Results 1581 stored clinical RVP samples were tested for SPNEU DNA with PCR to lytA, 1550 of these had complete RVP panel results available for analysis. RVP samples from patients 0–5 years old were more likely to have a viral or bacterial pathogen detected than > 5 years old (78% vs. 45%, P < 0.001). Of 1,550 samples analyzed with SPNEU PCR, 19% were positive for SPNEU, this was more likely in those 0–5 years old than > 5 years old (50% vs. 10%, P < 0.0001). In 0–5 years old, SPNEU was more frequently detected when multiple pathogens were detected on RVP vs. those with no pathogen (63% vs. 43%, P = 0.031). In > 5 years old, compared with no pathogen samples, the presence of multiple pathogens, any single pathogen, influenza, rhinovirus and Bordetella pertussis were significantly associated with higher SPNEU positivity rates. Median SPNEU PCR DNA load was higher in multiple pathogen and single pathogen samples than in no pathogen RVP samples. Conclusion We have demonstrated an association between common respiratory pathogens and detection of SPNEU DNA via PCR. This association is strongest in samples with multiple RVP pathogens, suggesting additional nasopharyngeal inflammation may contribute to SPNEU presence in the nasopharynx. Previous data have focused on those 0–5 years old, we have demonstrated an SPNEU-viral association in those > 5 years old. This tool may be clinically useful to determine which individuals with viral respiratory tract infection will progress to bacterial pneumonia and warrants further investigation. Disclosures All authors: No reported disclosures.