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Li Z, Zhang X, Sun H, Hao C, Shao X, Xu J, Zhang X, Wang Y. Clinical characteristics of persistent or recurrent pneumonia combined with airway malacia in children. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13767. [PMID: 38685746 PMCID: PMC11058396 DOI: 10.1111/crj.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The aim of this study is to investigate the clinical characteristics and pathogens involved in persistent or recurrent pneumonia combined with airway malacia in children. METHODS We retrospectively reviewed the information of children hospitalised with persistent or recurrent pneumonia, including clinical presentations, laboratory examination results and pathogens. RESULTS A total of 554 patients were admitted, 285 (51.44%) of whom were found to have airway malacia. There were 78 (27.37%), 166 (58.25%) and 41 (14.39%) patients with mild, moderate and severe malacia, respectively. Patients with airway malacia were younger than those without malacia (6.0 vs. 12.0 months, p < 0.01) and were more likely to present with wheezing (75.07%), fever (34.39%), dyspnoea (28.77%), cyanosis (13.68%) and wheezing in the lungs (78.95%). The incidence of preterm delivery, oxygen therapy, paediatric intensive care unit (PICU) admission and mechanical ventilation was higher, and the hospital stay (11.0 vs. 10.0 days, p = 0.04) was longer in these patients than in those without malacia. Patients with severe airway malacia were more likely to undergo oxygen therapy, PICU admission, mechanical ventilation and have multiple malacia than were those with mild or moderate malacia. Mycoplasma pneumoniae (30.18%) was the most common pathogen. CONCLUSION Severe airway malacia likely aggravates conditions combined with pneumonia. The proportion of multisite malacia was greater in severe airway malacia patients.
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Affiliation(s)
- Zhuxia Li
- Department of Respiratory MedicineChildren's Hospital of Soochow UniversitySuzhouChina
| | - Xinxing Zhang
- Department of Respiratory MedicineChildren's Hospital of Soochow UniversitySuzhouChina
| | - Huiquan Sun
- Department of Respiratory MedicineChildren's Hospital of Soochow UniversitySuzhouChina
| | - Chuangli Hao
- Department of Respiratory MedicineChildren's Hospital of Soochow UniversitySuzhouChina
| | - Xuejun Shao
- Department of Laboratory Medicine, Department of Clinical LaboratoryChildren's Hospital of Soochow UniversitySuzhouChina
| | - Jun Xu
- Department of Laboratory Medicine, Department of Clinical LaboratoryChildren's Hospital of Soochow UniversitySuzhouChina
| | - Xin Zhang
- Department of Laboratory Medicine, Department of Clinical LaboratoryChildren's Hospital of Soochow UniversitySuzhouChina
| | - Yuqing Wang
- Department of Respiratory MedicineChildren's Hospital of Soochow UniversitySuzhouChina
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冯 荣, 周 丽, 窦 蕊, 周 雪, 王 莉, 韩 丽, 王 育. [Application of metagenomic next-generation sequencing of bronchoalveolar lavage fluid in the diagnosis and treatment of refractory pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:1253-1258. [PMID: 38112143 PMCID: PMC10731966 DOI: 10.7499/j.issn.1008-8830.2307106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES To investigate the clinical application of metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) in the etiological diagnosis and treatment of refractory pneumonia (RTP) in children. METHODS A retrospective analysis was performed on 160 children with RTP who were admitted to the Department of Pediatric Internal Medicine, Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, from January 2020 to March 2023. According to whether mNGS was performed, they were divided into two groups: mNGS (n=80) and traditional testing (n=80). All children received the tests of inflammatory markers and pathogen tests after admission. Traditional pathogenicity tests included microbial culture (sputum specimen collected by suction tube), nucleic acid detection of respiratory pathogens, and serological test (mycoplasma, tuberculosis, and fungi). For the mNGS group, BALF specimens were collected after bronchoscopy and were sent to the laboratory for mNGS and microbial culture. The two groups were analyzed and compared in terms of the detection of pathogens and treatment. RESULTS Compared with the traditional testing group, the mNGS group had a significantly higher detection rate of pathogens (92% vs 58%, P<0.05), with more types of pathogens and a higher diagnostic rate of mixed infections. Compared with the traditional testing group, the mNGS group had a significantly higher treatment response rate and a significantly lower incidence rate of complications during hospitalization (P<0.05). Treatment was adjusted for 68 children in the mNGS group according to the results of mNGS, with a treatment response rate of 96% (65/68) after adjustment. CONCLUSIONS Compared with traditional pathogen tests, BALF mNGS can significantly improve the detection rate of pathogens and find some rare pathogens. In clinical practice, when encountering bottlenecks during the diagnosis and treatment of children with RTP, it is advisable to promptly perform the mNGS to identify the pathogens.
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Affiliation(s)
| | | | - 蕊 窦
- 内蒙古医科大学 第二附属医院超声医学中心,内蒙古呼和浩特010010
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Sun Y, Chen Y, Li X, Liao Y, Chen X, Song Y, Liang X, Dai Y, Chen D, Ning G. Three-dimensional ultrashort echo time magnetic resonance imaging in pediatric patients with pneumonia: a comparative study. BMC Med Imaging 2023; 23:175. [PMID: 37919642 PMCID: PMC10621158 DOI: 10.1186/s12880-023-01130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND UTE has been used to depict lung parenchyma. However, the insufficient discussion of its performance in pediatric pneumonia compared with conventional sequences is a gap in the existing literature. The objective of this study was to compare the diagnostic value of 3D-UTE with that of 3D T1-GRE and T2-FSE sequences in young children diagnosed with pneumonia. METHODS Seventy-seven eligible pediatric patients diagnosed with pneumonia at our hospital, ranging in age from one day to thirty-five months, were enrolled in this study from March 2021 to August 2021. All patients underwent imaging using a 3 T pediatric MR scanner, which included three sequences: 3D-UTE, 3D-T1 GRE, and T2-FSE. Subjective analyses were performed by two experienced pediatric radiologists based on a 5-point scale according to six pathological findings (patchy shadows/ground-glass opacity (GGO), consolidation, nodule, bulla/cyst, linear opacity, and pleural effusion/thickening). Additionally, they assessed image quality, including the presence of artifacts, and evaluated the lung parenchyma. Interrater agreement was assessed using intraclass correlation coefficients (ICCs). Differences among the three sequences were evaluated using the Wilcoxon signed-rank test. RESULTS The visualization of pathologies in most parameters (patchy shadows/GGO, consolidation, nodule, and bulla/cyst) was superior with UTE compared to T2-FSE and T1 GRE. The visualization scores for linear opacity were similar between UTE and T2-FSE, and both were better than T1-GRE. In the case of pleural effusion/thickening, T2-FSE outperformed the other sequences. However, statistically significant differences between UTE and other sequences were only observed for patchy shadows/GGO and consolidation. The overall image quality was superior or at least comparable with UTE compared to T2-FSE and T1-GRE. Interobserver agreements for all visual assessments were significant and rated "substantial" or "excellent." CONCLUSIONS In conclusion, UTE MRI is a useful and promising method for evaluating pediatric pneumonia, as it provided better or similar visualization of most imaging findings compared with T2-FSE and T1-GRE. We suggest that the UTE MRI is well-suited for pediatric population, especially in younger children with pneumonia who require longitudinal and repeated imaging for clinical care or research and are susceptible to ionizing radiation.
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Affiliation(s)
- Yan Sun
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yujie Chen
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xuesheng Li
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Liao
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xijian Chen
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yu Song
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Xinyue Liang
- Central Research Institute, United Imaging Healthcare, Shanghai, People's Republic of China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, People's Republic of China
| | - Dapeng Chen
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China
- Department of Pediatrics, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China
| | - Gang Ning
- Department of Radiology, West China Second Hospital, Sichuan University, No.1416, Section 1, Chenglong Road, Chengdu, Sichuan Province, 610066, People's Republic of China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Xu C, Tao X, Zhu J, Hou C, Liu Y, Fu L, Zhu W, Yang X, Huang Y. Clinical features and risk factors analysis for poor outcomes of severe community-acquired pneumonia in children: a nomogram prediction model. Front Pediatr 2023; 11:1194186. [PMID: 37808557 PMCID: PMC10552538 DOI: 10.3389/fped.2023.1194186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background Pneumonia remains the leading cause of death among children aged 1-59 months. The early prediction of poor outcomes (PO) is of critical concern. This study aimed to explore the risk factors relating to PO in severe community-acquired pneumonia (SCAP) and build a PO-predictive nomogram model for children with SCAP. Methods We retrospectively identified 300 Chinese pediatric patients diagnosed with SCAP who were hospitalized in the Affiliated Hospital of Southwest Medical University from August 1, 2018, to October 31, 2021. Children were divided into the PO and the non-PO groups. The occurrence of PO was designated as the dependent variable. Univariate and multivariate logistic regression analyses were used to identify the risk factors of PO. A nomogram model was constructed from the multivariate logistic regression analysis and internally validated for model discrimination and calibration. The performance of the nomogram was estimated using the concordance index (C-index). Results According to the efficacy evaluation criteria, 56 of 300 children demonstrated PO. The multivariate logistic regression analysis resulted in the following independent risk factors for PO: co-morbidity (OR: 8.032, 95% CI: 3.556-18.140, P < 0.0001), requiring invasive mechanical ventilation (IMV) (OR: 7.081, 95% CI: 2.250-22.282, P = 0.001), and ALB < 35 g/L (OR: 3.203, 95% CI: 1.151-8.912, P = 0.026). Results of the internal validation confirmed that the model provided good discrimination (concordance index [C-index], 0.876 [95% CI: 0.828-0.925]). The calibration plots in the nomogram model were of high quality. Conclusion The nomogram facilitated accurate prediction of PO in children diagnosed with SCAP and could be helpful for clinical decision-making.
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Affiliation(s)
- Changjing Xu
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuemei Tao
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Junlong Zhu
- Department of Vascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chao Hou
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yujie Liu
- Department of Geriatric Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liya Fu
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Wanlong Zhu
- School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Xuping Yang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilan Huang
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Cotter JM, Florin TA, Moss A, Suresh K, Navanandan N, Ramgopal S, Shah SS, Ruddy R, Kempe A, Ambroggio L. Antibiotic use and outcomes among children hospitalized with suspected pneumonia. J Hosp Med 2022; 17:975-983. [PMID: 36380654 PMCID: PMC9722550 DOI: 10.1002/jhm.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although viral etiologies predominate, antibiotics are frequently prescribed for community-acquired pneumonia (CAP). OBJECTIVE We evaluated the association between antibiotic use and outcomes among children hospitalized with suspected CAP. DESIGNS, SETTINGS AND PARTICIPANTS We performed a secondary analysis of a prospective cohort of children hospitalized with suspected CAP. INTERVENTION The exposure was the receipt of antibiotics in the emergency department (ED). MAIN OUTCOME AND MEASURES Clinical outcomes included length of stay (LOS), care escalation, postdischarge treatment failure, 30-day ED revisit, and quality-of-life (QoL) measures from a follow-up survey 7-15 days post discharge. To minimize confounding by indication (e.g., radiographic CAP), we performed inverse probability treatment weighting with propensity analyses. RESULTS Among 523 children, 66% were <5 years, 88% were febrile, 55% had radiographic CAP, and 55% received ED antibiotics. The median LOS was 41 h (IQR: 25, 54). After propensity analyses, there were no differences in LOS, escalated care, treatment failure, or revisits between children who received antibiotics and those who did not. Seventy-one percent of patients completed follow-up surveys after discharge. Among 16% of patients with fevers after discharge, the median fever duration was 2 days, and those who received antibiotics had a 37% decrease in the mean number of days with fever (95% confidence interval: 20% and 51%). We found no statistical differences in other QoL measures.
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Affiliation(s)
- Jillian M Cotter
- Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Todd A Florin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Angela Moss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Krithika Suresh
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Sriram Ramgopal
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Richard Ruddy
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | - Lilliam Ambroggio
- Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
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Tian J, Wang XL, Wang LC, Chen F, Tian Y, Ma L, Pan CY, Wang YP. Qiangli Wuhu mixture alleviates LPS-induced pneumonia by inhibiting the TLR4/NF-κB/NLRP3 pathway: a study based on network pharmacology. PHARMACEUTICAL BIOLOGY 2022; 60:1331-1340. [PMID: 35819372 PMCID: PMC9291688 DOI: 10.1080/13880209.2022.2093384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Qiangli Wuhu (QLWH) mixture is a concoction approved and registered by Ningxia Medical Products Administration. It has therapeutic effects on various types of pneumonia. OBJECTIVE To clarify the mechanisms of QLWH in treating pneumonia. MATERIALS AND METHODS The potential targets of QLWH in the treatment of pneumonia were predicted by network pharmacology. Male, Institute of Cancer Research (ICR) mice were randomly divided into five groups of 12 mice, control, vehicle, QLWH (10 and 20 mg/kg) and dexamethasone (DXM), and orally treated twice daily with normal saline, QLWH or DXM. The pneumonia model was established by tracheal instillation of lipopolysaccharide (LPS). After treatment five days, ELISA, H&E staining and Western blot were used to investigate protective effects of QLWH. RESULTS Nine hundred and ninety-four active ingredients were found through network pharmacology, corresponding to 135 targets for the treatment of pneumonia; compared to the vehicle group, QLWH (10 and 20 mg/kg) significantly decreased the levels of TNF-α (14.3% and 28.8%), IL-1β (23.9% and 42.8%) and IL-6 (13.2% and 16.1%), increased the levels of IL-10 (134.3% and 172.9%); in terms of mechanism, QLWH down-regulated TLR4/NF-κB/NLRP3 axis related proteins in lung tissue of pneumonia model mice (p < 0.05). DISCUSSION AND CONCLUSIONS This study combined network pharmacology and animal experiments, providing effective evidence for the clinical promotion of QLWH. Meanwhile, it is of significance for further development.
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Affiliation(s)
- Jie Tian
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Xiao-Long Wang
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | | | - Fei Chen
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, China
| | - Yun Tian
- Ningxia Chinese Medicine Research Center, Yinchuan, China
- School of Education, Monash University, Melbourne, Australia
| | - Li Ma
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Chao-Yun Pan
- Ningxia Chinese Medicine Research Center, Yinchuan, China
| | - Yan-Ping Wang
- Ningxia Chinese Medicine Research Center, Yinchuan, China
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Cotter JM, Hall M, Shah SS, Molloy MJ, Markham JL, Aronson PL, Stephens JR, Steiner MJ, McCoy E, Collins M, Tchou MJ. Variation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections. J Hosp Med 2022; 17:872-879. [PMID: 35946482 DOI: 10.1002/jhm.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current diagnostics do not permit reliable differentiation of bacterial from viral causes of lower respiratory tract infection (LRTI), which may lead to over-treatment with antibiotics for possible bacterial community-acquired pneumonia (CAP). OBJECTIVES We sought to describe variation in the diagnosis and treatment of bacterial CAP among children hospitalized with LRTIs and determine the association between CAP diagnosis and outcomes. DESIGN, SETTING AND PARTICIPANTS This multicenter cross-sectional study included children hospitalized between 2017 and 2019 with LRTIs at 42 children's hospitals. MAIN OUTCOME AND METHODS We calculated the proportion of children with LRTIs who were diagnosed with and treated for bacterial CAP. After adjusting for confounders, hospitals were grouped into high, moderate, and low CAP diagnosis groups. Multivariable regression was used to examine the association between high and low CAP diagnosis groups and outcomes. RESULTS We identified 66,581 patients hospitalized with LRTIs and observed substantial variation across hospitals in the proportion diagnosed with and treated for bacterial CAP (median 27%, range 12%-42%). Compared with low CAP diagnosing hospitals, high diagnosing hospitals had higher rates of CAP-related revisits (0.6% [95% confidence interval: 0.5, 0.7] vs. 0.4% [0.4, 0.5], p = .04), chest radiographs (58% [53, 62] vs. 46% [41, 51], p = .02), and blood tests (43% [33, 53] vs. 26% [19, 35], p = .046). There were no significant differences in length of stay, all-cause revisits or readmissions, CAP-related readmissions, or costs. CONCLUSION There was wide variation across hospitals in the proportion of children with LRTIs who were treated for bacterial CAP. The lack of meaningful differences in clinical outcomes among hospitals suggests that some institutions may over-diagnose and overtreat bacterial CAP.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Molloy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R Stephens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael J Steiner
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisha McCoy
- Department of Pediatrics and Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Megan Collins
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael J Tchou
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Li J, Wang Y, Sheng Q, Liu X, Xing Z, Sun F, Wang Y, Li S, Li Y, Yu Y, Yu G. Interpretable modeling and discovery of key predictors for pneumonia diagnosis in children based on electronic medical records. Digit Health 2022; 8:20552076221131185. [PMID: 36276188 PMCID: PMC9583222 DOI: 10.1177/20552076221131185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/20/2022] [Indexed: 11/15/2022] Open
Abstract
Background Community-acquired pneumonia is one of the most common infectious diseases in children and is a leading cause of death among children under 5 years of age, resulting in high rates of antibiotic usage and hospitalization. It is of extremely practical significance to make full use of the existing electronic medical records to study pneumonia and to establish automatic diagnosis models for pneumonia. Methods We established pneumonia diagnosis models of Bayesian network using a total of 13,448 electronic medical records. We investigated learning network structure and parameter estimation and evaluated different structure learning strategies and various modeling methods. By identifying the key predictors of model, the pneumonia status was analyzed. Results The performance of the proposed Bayesian network was evaluated using a set of 3361 cases with a precision of 0.7861, a recall of 0.9889, and an F1-score of 0.8759. On an independent external validation set containing 4925 cases, Bayesian network achieved a precision of 0.7382, a recall of 0.9947, and an F1-score of 0.8475. Our proposed Bayesian network outperformed all other methods, including CatBoost, XGBoost, LightGBM, logistic regression, and ridge classification. Conclusion The appropriate feature selection improved the performance of Bayesian networks. The proposed Bayesian network had good generalizability and could be directly applied to clinical research centers. And the key predictors identified by the network demonstrated good clinical interpretability, allowing for a better understanding of pneumonia status and complications. This study had important clinical value and practical significance for the research and diagnosis of pediatric pneumonia.
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Affiliation(s)
- Jing Li
- Department of Data and Information, The Children's Hospital,
Zhejiang University School of Medicine, Hangzhou, China,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang
Province, Hangzhou, China
| | - Yingshuo Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, China
| | - Qiuyang Sheng
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China
| | - Xiaoqing Liu
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China
| | - Zijian Xing
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China
| | - Fenglei Sun
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China
| | - Yuqi Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, China
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang
University School of Medicine, Hangzhou, China
| | - Yiming Li
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China
| | - Yizhou Yu
- Deepwise Healthcare Artificial Intelligence Laboratory, Beijing,
China,Yizhou Yu, Deepwise Healthcare Artificial
Intelligence Laboratory, 13th Floor, Building 2, Yard 2, Xisanhuan North Road,
Haidian District, Beijing, China.
| | - Gang Yu
- Department of Data and Information, The Children's Hospital,
Zhejiang University School of Medicine, Hangzhou, China,Sino-Finland Joint AI Laboratory for Child Health of Zhejiang
Province, Hangzhou, China,Polytechnic Institute, Zhejiang University, Hangzhou, China ,Gang Yu, Department of Data and
Information, The Children’s Hospital, Zhejiang University School of Medicine,
3333 Binsheng Road, Binjiang District, Hangzhou 310052, China.
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Haggie S, Barnes EH, Selvadurai H, Gunasekera H, Fitzgerald DA. Paediatric pneumonia: deriving a model to identify severe disease. Arch Dis Child 2022; 107:491-496. [PMID: 34758964 DOI: 10.1136/archdischild-2021-322665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of childhood hospitalisation. Limited data exist on factors predicting severe disease with no paediatric-specific predictive tools. METHODS Retrospective cohort (2011-2016) of hospitalised CAP cases. We analysed clinical variables collected at hospital presentation against outcomes. Stratified outcomes were mild (hospitalised), moderate (invasive drainage procedure, intensive care) or severe (mechanical ventilation, vasopressors, death). RESULTS We report 3330 CAP cases, median age 2.0 years (IQR 1-5 years), with 2950 (88.5%) mild, 305 (9.2%) moderate and 75 (2.3%) severe outcomes. Moderate-severe outcomes were associated with hypoxia (SaO2 <90%; OR 6.6, 95% CI 5.1 to 8.5), increased work of breathing (severe vs normal OR 5.8, 95% CI 4.2 to 8.0), comorbidities (4+ comorbidities vs nil; OR 8.8, 95% CI 5.5 to 14) and being indigenous (OR 4.7, 95% CI 2.6 to 8.4). Febrile children were less likely than afebrile children to have moderate-severe outcomes (OR 0.57 95% CI 0.44 to 0.74). The full model receiver operating characteristic (ROC) area under the curve (AUC) was 0.78. Sensitivity analyses showed similar results with clinical or radiological CAP definitions. We derived a clinical tool to stratify low, intermediate or high likelihood of severe disease (AUC 0.72). High scores (≥5) had nearly eight times higher odds of moderate-severe disease than those with a low (≤1) score (OR 7.7 95% CI 5.6 to 10.5). CONCLUSIONS A clinical risk prediction tool is needed for child CAP. We have identified risk factors and derived a simple clinical tool using clinical variables at hospital presentation to determine a child's risk of invasive or intensive care treatment with an ROC AUC comparable with adult pneumonia tools.
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Affiliation(s)
- Stuart Haggie
- The Children's Hospital Westmead, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Hiran Selvadurai
- Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hasantha Gunasekera
- Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
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10
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Age-specific risk factors of severe pneumonia among pediatric patients hospitalized with community-acquired pneumonia. Ital J Pediatr 2021; 47:100. [PMID: 33892752 PMCID: PMC8062938 DOI: 10.1186/s13052-021-01042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk factors that predispose the development of severe community-acquired pneumonia (CAP) among pediatric CAP patients of different age ranges are yet to be identified. METHODS We retrospectively analyzed pediatric in-patients (< 6 years old) diagnosed with CAP in our hospital. We subdivided patients into four age groups (< 6 months, 6 months-1 year, 1-2 years, and 2-6 years). Their medical records, including demographic information, clinical features, laboratory findings, and chest radiographic reports, were reviewed and collected for further analysis. Univariate logistic regression analysis and stepwise regression analysis were applied to identify risk factors associated with severe CAP and ICU admission for overall patients and age-stratified subgroups. RESULTS A total of 20,174 cases were initially included. Among them, 3309 (16.40%) cases were identified as severe CAP, and 2824 (14.00%) cases required ICU admission. Potential risk factors for severe CAP and ICU admission identified by univariate analysis included younger age, rural residency, premature birth, low birth weight (LBW), formula feeding, congenital heart disease (CHD), history of pneumonia or neonatal jaundice, patients with other health issues, certain symptoms (manifesting wheezing, dyspnea, cyanosis, but have no cough or fever), abnormal laboratory findings (abnormal levels of white blood cells, albumin, and C-reactive protein and RSV infection), and chest X-ray (odds ratio [OR] > 1 for all). CHD, low albumin, proteinuria, abnormal chest x-ray were independent risks factors across different age groups, whereas birth or feeding history, history of pneumonia, cyanosis or dyspnea on admission, and RSV infection were independent risk factors for only younger kids (< 1 year), and wheezing was an independent risk factor only for older children (2-5 years old). CONCLUSIONS Risk factors predicting disease severity among children hospitalized with CAP vary with age. Risk factor stratification of pediatric CAP based on age-specific risk factors can better guide clinical practice. TRIAL REGISTRATION This study has been registered in China, with the registration number being ChiCTR2000033019 .
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11
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Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia. Sci Rep 2020; 10:4579. [PMID: 32165709 PMCID: PMC7067858 DOI: 10.1038/s41598-020-61348-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/26/2020] [Indexed: 12/23/2022] Open
Abstract
The presence of bronchial mucus plugs (BMP) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMP presence in children with MPP were proposed using a cohort of patients who underwent bronchoscopy intervention at Children’s Hospital in Eastern China. Patients with MPP in an earlier period formed the training cohort (n = 872) for nomogram development, and those thereafter formed the validation cohort (n = 399) to confirmed model’s performance. BMP in children with MPP were found in 196 (22.5%) and 91(22.8%) patients in the training and validation cohorts, respectively. The independent risk factors associated with BMP were age >5years (OR 2.06; 95% CI 1.43 to 2.98), higher IL-10 level (>10 ng/L, 2.19; 95% CI 1.46 to 3.28), higher IFN-γ level (>30 ng/L, 1.69; 95% CI 1.13 to 2.54), and presence of complication (3.43; 95% CI 1.45 to 8.09). Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.771(95% CI, 0.734–0.808) and 0.796 (95% CI, 0.744–0.848) in predicting BMP in the training and validation cohorts, respectively. The nomogram achieved an optimal prediction of BMP in children with MPP. Using this model, the risk of BMP formation would be determined, contributing to a rational therapeutic choice.
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12
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Xu X, Wu L, Sheng Y, Liu J, Xu Z, Kong W, Tang L, Chen Z. Airway microbiota in children with bronchial mucus plugs caused by Mycoplasma pneumoniae pneumonia. Respir Med 2020; 170:105902. [PMID: 32843185 DOI: 10.1016/j.rmed.2020.105902] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/29/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is increasing evidence for a role of lung microbiota in the pathogenesis of Mycoplasma pneumoniae pneumonia (MPP). However, the alterations of lung microbiota in MPP with bronchial mucus plugs and its role in disease pathogenesis remain poorly understood. METHODS In this prospective observational study, we performed a longitudinal 16S rRNA-based microbiome survey on bronchoalveolar lavage (BAL) samples collected from 31 MPP with bronchial mucus plugs and 52 MPP without mucus plugs. RESULTS Our study showed a clear difference in airway microbiota between MPP children with and without bronchial mucus plugs. The MPP children with mucus plugs had lower abundances of Sphingomonas and Elizabethkingia, and a high abundance of Mycoplasma compared with MPP children without mucus plugs, subsequently contributing to increased ratios of Mycoplasma to Sphingomonas and Mycoplasma to Elizabethkingia. Children's age, fever time and serum cytokine levels were associated with airway microbiota alteration. Furthermore, significant correlations between bacterial genus abundances were found in MPP children with mucus plugs. CONCLUSIONS Our results suggest an impact of airway microbiota on the clinical course of MPP in children, deserving further investigations.
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Affiliation(s)
- Xuefeng Xu
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China; Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Lei Wu
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Yuanjian Sheng
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Jinling Liu
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Zhufei Xu
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Weixing Kong
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Lanfang Tang
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China
| | - Zhimin Chen
- Department of Respiratory Medicine, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, PR China.
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13
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Dela Cruz CS, Wunderink RG, Christiani DC, Cormier SA, Crothers K, Doerschuk CM, Evans SE, Goldstein DR, Khatri P, Kobzik L, Kolls JK, Levy BD, Metersky ML, Niederman MS, Nusrat R, Orihuela CJ, Peyrani P, Prince AS, Ramírez JA, Ridge KM, Sethi S, Suratt BT, Sznajder JI, Tsalik EL, Walkey AJ, Yende S, Aggarwal NR, Caler EV, Mizgerd JP. Future Research Directions in Pneumonia. NHLBI Working Group Report. Am J Respir Crit Care Med 2019; 198:256-263. [PMID: 29546996 DOI: 10.1164/rccm.201801-0139ws] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group's specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia.
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Affiliation(s)
- Charles S Dela Cruz
- 1 Pulmonary, Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Richard G Wunderink
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David C Christiani
- 3 Department of Environmental Health, Harvard T. H. Chan School of Public Health, and.,4 Pulmonary and Critical Care Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Stephania A Cormier
- 5 Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Kristina Crothers
- 6 Department of Medicine, University of Washington, Seattle, Washington
| | - Claire M Doerschuk
- 7 Marsico Lung Institute and.,8 Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott E Evans
- 9 Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Goldstein
- 10 Department of Internal Medicine.,11 Department of Microbiology and Immunology, and.,12 Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Purvesh Khatri
- 13 Center for Biomedical Information Research, Stanford University, Stanford, California
| | - Lester Kobzik
- 3 Department of Environmental Health, Harvard T. H. Chan School of Public Health, and
| | - Jay K Kolls
- 14 Center for Translational Research in Infection and Inflammation, Tulane School of Medicine, New Orleans, Louisiana
| | - Bruce D Levy
- 15 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark L Metersky
- 16 Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael S Niederman
- 17 Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Roomi Nusrat
- 18 Department of Medicine, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Carlos J Orihuela
- 19 Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Peyrani
- 20 Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Alice S Prince
- 21 Department of Pediatrics, Columbia University, New York, New York
| | - Julio A Ramírez
- 20 Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Karen M Ridge
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjay Sethi
- 22 Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Benjamin T Suratt
- 23 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Jacob I Sznajder
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ephraim L Tsalik
- 24 Emergency Medicine Service, Durham Veterans Affairs Health Care System, Durham, North Carolina.,25 Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Allan J Walkey
- 26 Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sachin Yende
- 27 Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,28 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and
| | - Neil R Aggarwal
- 29 Division of Lung Diseases, NHLBI, NIH, Bethesda, Maryland
| | | | - Joseph P Mizgerd
- 26 Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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14
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Jiao F, Chen J, Wang M, Kumar SA, Li X, Han T. Determination of Procalcitonin, C-Reactive Protein and White Blood Cell Levels to Diagnose Community-Acquired Pneumonia (CAP). Indian J Pediatr 2019; 86:763. [PMID: 30949918 DOI: 10.1007/s12098-019-02938-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Fuyong Jiao
- Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jianping Chen
- Tianyou Children's Hospital, Guangdong, People's Republic of China
| | - Mengmeng Wang
- Department of Clinical Medicine, Xi'an Medical University, Xi'an, People's Republic of China
| | - Senthil Arun Kumar
- School of Biotechnology/Bioinformatics, D Y Patil Deemed to be University, CBD Belapur, Navi Mumbai, Maharashtra, India.
| | - Xiaohong Li
- Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Tiantian Han
- Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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15
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Principi N, Esposito S. Emerging problems in the treatment of pediatric community-acquired pneumonia. Expert Rev Respir Med 2018; 12:595-603. [PMID: 29883232 DOI: 10.1080/17476348.2018.1486710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) remains one of the most common reasons for paediatric morbidity and accounts for about 16% of all the deaths occurring in children less than 5 years of age. Areas covered: The main aim of this paper is to discuss the emerging problems for CAP treatment in paediatric age. Expert commentary: Official recommendations for therapeutic approaches to paediatric CAP, despite being not very recent, seem still to be the best solution to assure the highest probabilities of cure for children with this disease living in industrialized countries. Amoxicillin remains the drug of choice and use of macrolides alone or in combination does not seem supported by solid evidence. Corticosteroids can be useful in CAP associated with bronco-obstruction, whereas their effectiveness in cases with a severe inflammatory response, although plausible, is not supported by data collected through randomized, placebo-controlled trials. Finally, for the administration of vitamin C and vitamin D, the available data are not adequate to draw firm conclusions regarding the real importance of supplementation. Further studies are needed to evaluate which modifications of presently available recommendations for paediatric CAP treatment can improve final prognosis of this still common disease.
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Affiliation(s)
| | - Susanna Esposito
- b Pediatric Clinic, Department of Surgical and Biomedical Sciences , Università degli Studi di Perugia , Perugia , Italy
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16
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Mamani M, Muceli N, Ghasemi Basir HR, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J Gen Med 2017; 10:423-429. [PMID: 29180888 PMCID: PMC5692194 DOI: 10.2147/ijgm.s149049] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with infectious diseases. The aim of this study was to compare the levels of vitamin D between patients with CAP and healthy controls. Methods In a case-control study on 73 patients with CAP and 76 healthy controls, the serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured. Severity and outcomes of disease and also duration of hospital stay were compared in patients with different levels of 25(OH)D. The severity of CAP was assessed using the CURB-65 score (confusion, uremia, respiratory rate, low blood pressure, age ≥65 years) and was also reflected by the length of hospital stay, admission to intensive care unit (ICU), and 30-day mortality. Results In total, 81.2% of the study population had vitamin D levels <30 ng/dL. The risk of pneumonia among subjects with deficient vitamin D levels was 3.69 (95% CI: 1.46, 9.31) times of those with sufficient vitamin D level (P=0.006). Prevalence of severe deficiency of vitamin D in scores three and four of CURB-65 (59.38%), was far more than scores one and two (31.71%). Also, results indicated patients with severe deficiency had a higher risk for ICU admission, 30-day mortality, and longer hospitalization stay, but these were not statistically significant. Conclusion According to findings, a low level of 25(OH)D is associated with a higher incidence of CAP and more severe disease. It is recommended to pay more attention to vitamin D deficiency in infectious diseases, particularly in CAP patients.
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Affiliation(s)
- Mojgan Mamani
- Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Infectious Disease, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Muceli
- Department of Infectious Disease, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Maryam Vasheghani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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17
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Hospitalisation for lower respiratory tract infection in children in the province of Quebec, Canada, before and during the pneumococcal conjugate vaccine era. Epidemiol Infect 2017; 145:2770-2776. [PMID: 28803551 DOI: 10.1017/s0950268817001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Streptococcus pneumoniae is an important cause of community-acquired pneumonia and pneumococcal conjugate vaccines (PCVs) may reduce this burden. This study's goal was to analyse trends in lower respiratory tract infections (LRTI) hospitalisations before and during a routine vaccination programme targeting all newborns with PCV was started in the province of Quebec, Canada in December 2004. The study population included hospital admissions with a main diagnosis of LRTI among 6-59 month-old Quebec residents from April 2000 to December 2014. Trends in proportions and rates were analysed using Cochran-Armitage tests and Poisson regression models. We observed a general downward trend in all LTRI hospitalisations rate: from 11·55/1000 person-years in 2000-2001 to 9·59/1000 in 2013-2014, a 17·0% reduction, which started before the introduction of PCV vaccination. Downward trends in hospitalisation rates were more pronounced for all-cause of pneumonia (minus 17·8%) than for bronchiolitis (minus 15·4%). There was also a decrease in the mean duration of hospital stay. There was little evidence that all-cause pneumonia decreased over the study period due mainly to the introduction of PCVs. Trends may be related to changes in clinical practice. This study casts doubt on the interpretation of ecological analyses of the implementation of PCV vaccination programmes.
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18
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Chen IC, Lin MY, Liu YC, Cheng HC, Wu JR, Hsu JH, Dai ZK. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children. PLoS One 2017; 12:e0173343. [PMID: 28301494 PMCID: PMC5354295 DOI: 10.1371/journal.pone.0173343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 02/20/2017] [Indexed: 11/18/2022] Open
Abstract
CONCLUSION TUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.
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Affiliation(s)
- I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiao-Chi Cheng
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JHH); (ZKD)
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JHH); (ZKD)
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19
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Alcoba G, Keitel K, Maspoli V, Lacroix L, Manzano S, Gehri M, Tabin R, Gervaix A, Galetto-Lacour A. A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR. Eur J Pediatr 2017; 176:815-824. [PMID: 28474099 PMCID: PMC7087038 DOI: 10.1007/s00431-017-2913-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/03/2017] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint. We showed that three clinical signs (unilateral hypoventilation, grunting, and absence of wheezing), elevated procalcitonin (PCT), C-reactive protein (CRP), negative nasopharyngeal viral PCR, or positive blood pneumococcal PCR (P-PCR) were significantly associated with both pneumonia with consolidation and complicated pneumonia. Children with negative clinical signs and low CRP values had a low probability of having pneumonia with consolidation (13%) or complicated pneumonia (6%). Associating the three clinical signs, CRP >80 mg/L and a positive P-PCR ruled in the diagnosis of complicated pneumonia with a positive predictive value of 75%. CONCLUSION A model incorporating clinical signs and laboratory markers can effectively assess the risk of having pneumonia. Children with negative clinical signs and low CRP are at a low risk of having pneumonia. For children with positive clinical signs and high CRP, a positive blood pneumococcal PCR can more accurately confirm the diagnosis of pneumonia. What is Known: • Distinguishing between bacterial and viral pneumonia in children is challenging. • Reducing the inappropriate use of antibiotics is a priority. What is New: • Children with negative clinical signs and low C-reactive protein (CRP) values have a low probability of having pneumonia. • Children with high CRP values can be tested using a pneumococcal PCR to rule in the diagnosis of pneumonia with a high positive predictive value.
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Affiliation(s)
- Gabriel Alcoba
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. .,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (Hôpitaux Universitaires de Genève, HUG), Rue Gabrielle-Perret-Gentil 4, CH-1211, Genève 14, Switzerland.
| | - Kristina Keitel
- Boston Children’s Hospital, Boston, MA USA ,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Veronica Maspoli
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Mario Gehri
- Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alain Gervaix
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Pediatric Emergency Medicine, Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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20
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Serum cytokine profile contributes to discriminating M. pneumoniae pneumonia in children. Cytokine 2016; 86:73-78. [DOI: 10.1016/j.cyto.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 01/18/2023]
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Chen Y, He H, Pan P, He S, Dong X, Chen Y, Wang S, Yu D. Rapid and combined detection of Mycoplasma pneumoniae, Epstein-Barr virus and human cytomegalovirus using AllGlo quadruplex quantitative PCR. J Med Microbiol 2016; 65:590-595. [PMID: 27093597 DOI: 10.1099/jmm.0.000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acute respiratory infections (ARIs) cause substantial morbidity and mortality worldwide. The causes of ARI are dynamic, and co-infections of Mycoplasma pneumoniae, Epstein-Barr virus and human cytomegalovirus are recently developed causes of ARI. Here, we established a quadruplex quantitative PCR (qPCR) method to rapidly identify and simultaneously detect a single infection or co-infection of these three pathogens and an internal control in a single tube using AllGlo probes. The analysis demonstrated a wide linear range of detection from 101 to 108 copies per test and a low coefficient of variation of less than 5 %. The amplification efficiencies were all close to 1, and the correlation coefficients (r2) were all greater than 0.99. We found no significant difference in a comparative reagent test (P >0.05). Moreover, the results of tests on clinical samples using AllGlo quadruplex qPCR and TaqMan uniplex qPCR were in near-perfect agreement (κ =0.97). Clinically, the availability of this method will enable better differential diagnosis, disease surveillance and controlled outcomes.
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Affiliation(s)
- Yi Chen
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Hui He
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Ping Pan
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Songzhe He
- Department of Clinical Laboratory, Affiliated Hospital of Guilin Medical University, Guilin, PR China
| | - Xueyan Dong
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Yueming Chen
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Shuying Wang
- Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
| | - Daojun Yu
- Affiliated First Hospital of Hangzhou, Zhejiang Chinese Medical University, Hangzhou, PR China.,Department of Clinical Laboratory, Hangzhou First People's Hospital, Hangzhou, PR China
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Abstract
Community-acquired pneumonia (CAP) is the most common acute infectious cause of death in children worldwide. Consequently, research into the epidemiology, diagnosis, treatment, and prevention of pediatric CAP spans the translational research spectrum. Herein, we aim to review the most significant findings reported by investigators focused on pediatric CAP research that has been reported in 2014 and 2015. Our review focuses on several key areas relevant to the clinical management of CAP. First, we will review recent advances in the understanding of CAP epidemiology worldwide, including the role of vaccination in the prevention of pediatric CAP. We also report on the expanding role of existing and emerging diagnostic technologies in CAP classification and management, as well as advances in optimizing antimicrobial use. Finally, we will review CAP management from the policy and future endeavors standpoint, including the influence of clinical practice guidelines on clinician management and patient outcomes, and future potential research directions that are in the early stages of investigation.
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Bibalo C, Apicella A, Guastalla V, Marzuillo P, Zennaro F, Tringali C, Taddio A, Germani C, Barbi E. Acute lobar nephritis in children: Not so easy to recognize and manage. World J Clin Pediatr 2016; 5:136-142. [PMID: 26862513 PMCID: PMC4737688 DOI: 10.5409/wjcp.v5.i1.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/27/2015] [Accepted: 12/18/2015] [Indexed: 02/06/2023] Open
Abstract
Acute lobar nephritis (ALN) is a localized non-liquefactive inflammatory renal bacterial infection, which typically involves one or more lobes. ALN is considered to be a midpoint in the spectrum of upper urinary tract infection, a spectrum ranging from uncomplicated pyelonephritis to intrarenal abscess. This condition may be difficult to recognize due to the lack of specific symptoms and laboratory findings. Therefore the disease is probably underdiagnosed. Computed tomography scanning represents the diagnostic gold standard for ALN, but magnetic resonance imagine could be considered in order to limit irradiation. The diagnosis is relevant since initial intravenous antibiotic therapy and overall length of treatment should not be shorter than 3 wk. We review the literature and analyze the ALN clinical presentation starting from four cases with the aim to give to the clinicians the elements to suspect and recognize the ALN in children.
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Van Bambeke F, Tulkens PM. The role of solithromycin in the management of bacterial community-acquired pneumonia. Expert Rev Anti Infect Ther 2016; 14:311-24. [DOI: 10.1586/14787210.2016.1138857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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