A population-based analysis of children with pneumonia among intensive care units in Taiwan

Assessing the utilization of antimicrobial agents in pediatric pneumonia during the era of the 13-valent pneumococcal conjugate vaccine: A retrospective, single-center study

BACKGROUND AND PURPOSE

Pneumonia and bronchopneumonia are the most common infectious diseases in children. This study aimed to analyze changes in causative pathogens and antibiotic use for bronchopneumonia or pneumonia after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in children.

METHODS

This retrospective study was conducted from 2009 to 2019. Hospitalized children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia or pneumonia were included to analyze changes in the potential mismatch between the diagnosed pathogen and antibiotic use.

RESULTS

The cohort comprised 1100 patients, including 648 (59%) and 452 (41%) with a discharge diagnosis of bronchopneumonia and pneumonia, respectively. The trend of viral pneumonia increased every year (rs = 0.101, p < 0.05) Antibiotics were administered in 97% patients, with an increasing annual trend in macrolide use (rs = 0.031, p = 0.009). Regarding antibiotic utilization, no significant variations were observed in the days of therapy (DOT) (rs = 0.076, p = 0.208) or length of therapy (LOT) (rs = -0.027, p = 0.534) per patient-year throughout the study duration. Interestingly, the LOT for combined therapy with macrolides and first-line beta-lactams was high (rs = 0.333, p = 0.028). In viral pneumonia treatment, neither the DOT nor LOT exhibited significant variations (rs = -0.006, p = 0.787 and rs = -0.156, p = 0.398).

CONCLUSION

After the introduction of PCV13 in Taiwan, no decrease in antibiotic use has been observed among children aged 6 months-3 years with a discharge diagnosis of bronchopneumonia and pneumonia.

Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan

BACKGROUND

To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: Retrospective review of medical records of all children (age 1 month to 18 years) admitted to PICU with CAP from January 2013 to March 2018 was done. Patients admitted in last 2 weeks before current illness and those with bronchiolitis (based on clinical diagnosis) were excluded. Data were collected on a structured proforma and included demographic, clinical data, comorbidities, therapeutic information, laboratory data, and outcome data. Results were presented as mean with SD and frequency with percentages. Factors associated with mortality were analyzed, using logistic regression for both univariate and multivariate analyses.

RESULTS

A total of 187 children with severe CAP were identified, 53.5% (n = 100) were <1 year of age and 65.2% (n = 122) were male, 32.6% (n = 61) were underweight, and 24.6% (n = 46) were stunted. A total of 94% (175) required mechanical ventilation. Mortality among the cohort was 20.3% (n = 38) with median length of mechanical ventilation 4 (2-8) days, and median length of PICU stay was 6 (4-12) days. PRISM score >10 on admission, presence of systemic illness, empyema, and length of PICU stay 14 (±2) days were associated with increased mortality among critically ill children admitted with CAP (p < .05).

CONCLUSIONS

Severe illness on presentation, presence of systemic illness and empyema are associated with increased mortality in children admitted to the PICU with severe CAP.

Factors associated with mortality in pediatric pneumonia patients supported with mechanical ventilation in developing country

Background

Pneumonia is still a major cause of death and incurs significant morbidity and mortality in developing countries. Thus, patients care does not only focus on treatment but also identifying factors that associated with the patient's outcome. Therefore we defined factors associated with mortality in pediatric pneumonia and assessed the outcome of pneumonia supported by mechanical ventilation in children.

Methods

We performed cohort retrospective study by collecting data of pediatric pneumonia patients who admitted to Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, from 2014 to 2016. Chi square and multivariate logistic regression tests were used to analyze the variables: anemia, comorbidities, bacteremia, age between 1-6 months old, and underweight as associated factors for mortality.

Results

One hundred and eleven children were included in this study. Those patients were diagnosed as community acquired pneumonia (79.3%), hospital acquired pneumonia (14.4%) and ventilator associated pneumonia (6.3%), with mortality rate 47.7%. Multivariate logistic regression analysis revealed that bacteremia, and underweight could be used as predictor factors of mortality for pediatric patients with pneumonia who were supported by mechanical ventilation with OR 2.5 (CI 95%: 1.03–6.1) and 2.4 (CI 95%: 1.1–5.7), respectively.

Conclusion

Factors associated with mortality for pediatric patients with pneumonia who were supported by mechanical ventilation were bacteremia and underweight. It is necessary to compare our findings with other centers.

Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study

BACKGROUND

Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP.

METHODS

This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia.

RESULTS

Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance.

CONCLUSIONS

The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.

Factors Associated With Pneumonia Severity in Children: A Systematic Review

Community-acquired pneumonia in children is associated with significant morbidity and mortality; however, data are limited in predicting which children will have negative outcomes, including clinical deterioration, severe disease, or development of complications. The Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pediatric pneumonia guideline includes criteria that were modified from adult criteria and define pneumonia severity to assist with resource allocation and site-of-care decision-making. However, the PIDS/IDSA criteria have not been formally developed or validated in children. Definitions for mild, moderate, and severe pneumonia also vary across the literature, further complicating the development of standardized severity criteria. This systematic review summarizes (1) the current state of the evidence for defining and predicting pneumonia severity in children as well as (2) emerging evidence focused on risk stratification of children with pneumonia.

Role of Pediatricians in the Ambulatory Care of Children in Taiwan, 1999-2011

BACKGROUND

Pediatricians are physicians trained to provide comprehensive nonsurgical health care for children, but parents may consult other specialists when seeking medical help for their children. This study was designed to analyze the role of pediatricians and the changes in the patterns of ambulatory visits among different specialties for children under the age of 18 years in Taiwan during the past 13 years.

METHODS

Data on ambulatory visits of children aged 0-17 years from 1999 to 2011 were retrieved from the National Health Insurance Research Database. The physician's specialty, level of the hospital, year of visit, age of the patient, and diagnoses of each ambulatory visit were analyzed. Four of the most commonly visited specialties-pediatrics, otolaryngology, family medicine, and internal medicine-were compared. The yearly trend of ambulatory visits to different specialties, difference in various age groups, influence of hospital levels, and the top 10 diagnoses were analyzed.

RESULTS

A total of 1,618,033 ambulatory visits were identified and enrolled into our study. A comparison of the proportions of ambulatory visits between 1999-2003 and 2007-2011 showed that the proportions of visits increased from 27.1 ± 1.3% to 35.4 ± 1.0% for pediatricians, decreased from 32.8 ± 1.8% to 17.0 ± 0.8% for family physicians, and did not change for otolaryngologists and internal medicine physicians. Specifically, pediatricians were visited more often if the children were younger, or if the health-care facility (level of hospital) was either a medical center or a regional hospital. Upper respiratory tract infection was the top diagnosis, followed by acute bronchitis, and acute and chronic tonsillitis.

CONCLUSIONS

The role of pediatricians in children's ambulatory care increased in importance from 1999 to 2011 in Taiwan. However, approximately two thirds of children sought ambulatory medical help from nonpediatric physicians. Thus, it is important to educate and encourage parents to visit pediatricians if their children require medical help.

A longitudinal study on early hospitalized airway infections and subsequent childhood asthma

Background

Acute airway infections, including bronchiolitis, are common causes of early childhood hospitalization. The development of later asthma may be related to early airway infections in young children. This study is to investigate the relationship between hospitalized airway infections (HAI) in young children (< 3 years old) and later childhood asthma.

Methods

Hospitalized children (< 3 years old) with bronchiolitis or other acute airway infections (other HAI group) from 1997-2000 were retrieved from the National Health Insurance Research Database of Taiwan, and compared to age- and gender-matched subjects with regards to asthma until 10 years of age; and potential comorbidities and medical care conditions.

Results

In total, 3,264 children (1,981 with bronchiolitis; 1,283 with other HAIs) were compared to 18,527 controls. The incidence of childhood asthma was higher in the study (16.2%) than the control (11.7%) group, and most cases were diagnosed between 3-5 years old. The hazard ratios were 1.583 (95% CI: 1.414-1.772) and 1.226 (95% CI: 1.053-1.428) for the bronchiolitis and other HAI subgroups, respectively, compared to the control group, and 1.228 (95% CI: 1.075-1.542) in the bronchiolitis subgroup compared to the other HAIs subgroup. A significantly higher odds ratio (1.973, 95% CI: 1.193-3.263) for the children with congenital heart disease (CHD) in the bronchiolitis subgroup was found at an age of 3-5 years compared to the control group.

Conclusions and Clinical Relevance

Young children (< 3 years old) hospitalized due to acute HAIs are at a higher risk of developing childhood asthma at age 3 to 10 years. The parents of children with HAIs at age 0 to 2 years should be informed for the higher risk of developing childhood asthma, especially in children with CHD and bronchiolitis.