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Wetzke M, Schütz K, Kopp MV, Seidenberg J, Vogelberg C, Ankermann T, Happle C, Voigt G, Köster H, Illig T, Lex C, Schuster A, Maier R, Panning M, Barten G, Rohde G, Welte T, Hansen G. Pathogen spectra in hospitalised and nonhospitalised children with community-acquired pneumonia. ERJ Open Res 2023; 9:00286-2022. [PMID: 36923566 PMCID: PMC10009707 DOI: 10.1183/23120541.00286-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Paediatric community-acquired pneumonia (CAP) is a leading cause of paediatric morbidity. However, particularly for outpatients with paediatric CAP, data on aetiology and management are scarce. Methods The prospective pedCAPNETZ study multicentrically enrols children and adolescents with outpatient-treated or hospitalised paediatric CAP in Germany. Blood and respiratory specimens were collected systematically, and comprehensive analyses of pathogen spectra were conducted. Follow-up evaluations were performed until day 90 after enrolment. Results Between December 2014 and August 2020, we enrolled 486 children with paediatric CAP at eight study sites, 437 (89.9%) of whom had radiographic evidence of paediatric CAP. Median (interquartile range) age was 4.5 (1.6-6.6) years, and 345 (78.9%) children were hospitalised. The most prevalent symptoms at enrolment were cough (91.8%), fever (89.2%) and tachypnoea (62.0%). Outpatients were significantly older, displayed significantly lower C-reactive protein levels and were significantly more likely to be symptom-free at follow-up days 14 and 90. Pathogens were detected in 90.3% of all patients (one or more viral pathogens in 68.1%; one or more bacterial strains in 18.7%; combined bacterial/viral pathogens in 4.1%). Parainfluenza virus and Mycoplasma pneumoniae were significantly more frequent in outpatients. The proportion of patients with antibiotic therapy was comparably high in both groups (92.4% of outpatients versus 86.2% of hospitalised patients). Conclusion We present first data on paediatric CAP with comprehensive analyses in outpatients and hospitalised cases and demonstrate high detection rates of viral pathogens in both groups. Particularly in young paediatric CAP patients with outpatient care, antibiotic therapy needs to be critically debated.
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Affiliation(s)
- Martin Wetzke
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,These authors contributed equally
| | - Katharina Schütz
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany.,These authors contributed equally
| | - Matthias Volkmar Kopp
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Department of Paediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Lübeck, Germany.,Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Jürgen Seidenberg
- Department of Paediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Christian Vogelberg
- University Children's Hospital, Technical University Dresden, Dresden, Germany
| | - Tobias Ankermann
- Department of Paediatric Pulmonology, Clinic of Pediatrics UKSH, University of Kiel, Kiel, Germany
| | - Christine Happle
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany
| | - Gesche Voigt
- Department of Paediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Lübeck, Germany
| | - Holger Köster
- Department of Paediatric Pneumology and Allergology, Universitätsklinik für Kinder- und Jugendmedizin Oldenburg, Oldenburg, Germany
| | - Thomas Illig
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | - Christiane Lex
- Department of Paediatric Pulmonology, University of Göttingen, Göttingen, Germany
| | - Antje Schuster
- Department of Paediatrics, University of Düsseldorf, Düsseldorf, Germany
| | - Ralph Maier
- Private Practice for Children, Tuttlingen, Germany
| | - Marcus Panning
- Institute of Virology, University of Freiburg, Freiburg, Germany
| | - Grit Barten
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,CAPNETZ STIFTUNG, Hannover, Germany
| | - Gernot Rohde
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Welte
- Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Department of Pulmonary Medicine, German Centre for Lung Research, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany.,Biomedical Research in End stage and Obstructive Lung Disease (BREATH) Hannover and Airway Research Center North (ARCN) Lübeck, Member of the German Center for Lung Research (DZL), Lübeck, Germany.,Excellence Cluster RESIST (EXC 2155), Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Hannover, Hannover, Germany
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Freedman J, Leibovitz E, Sergienko R, Levy A. Risk factors for hospitalization at the pediatric intensive care unit among infants and children younger than 5 years of age diagnosed with infectious diseases. Pediatr Neonatol 2022; 64:133-139. [PMID: 36184529 DOI: 10.1016/j.pedneo.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Children hospitalized with infectious diseases may develop severe, life-threatening conditions, often requiring admission to pediatric intensive care unit (PICU). The objectives of this study were to identify independent risk factors for PICU hospitalization with an infectious disease in children <5 years of age. METHODS In southern Israel, two populations live side by side: the middle-high income Jewish population and the low-income Bedouin population, both receiving equal and free medical care at the only tertiary medical center in the area. The study population included all children born in southern Israel and hospitalized at PICU with an infectious disease during 1991-2012. Risk factors for PICU hospitalizations were retrospectively studied by Kaplan-Meier and Cox proportional hazard survival analyses. RESULTS 9951 Jewish children and 18,002 Bedouin children were enrolled; overall, 1135 episodes of PICU hospitalizations with an infectious disease were recorded (879, 77.4% Bedouin and 256, 22.6% Jewish patients). Bedouin children had a higher risk for PICU hospitalization with an infectious disease compared with Jewish children (adjusted Hazard Ratio [adj. HR] 1.7, 95% CI 1.5-2.0); maternal multiparity and low-birth weight (<2500 g) were additional risk factors for PICU hospitalization with an infectious disease compared to firstborns (adj. HR = 1.2, 95% CI 1.0-1.5) or to children with a birth weight ≥2500 g (adj. HR = 1.5, 95% 1.2-1.9). Older age was a protective factor for PICU hospitalization (adj. HR = 0.98, 95% CI 0.97-0.99). Children hospitalized with a central nervous system infection had the highest risk of PICU hospitalization (adj. HR 6.8, 95% CI 5.5-8.4), followed by those with urinary tract infections (UTI, adj. HR 3.1, 95% CI 2.5-3.8) and those with lower respiratory tract infections (LRTI, adj. HR 2.9, 95% CI 2.4-3.4). CONCLUSION Bedouin ethnicity, low birth weight, maternal multiparity and younger age were significant risk factors for PICU hospitalizations with an infectious disease. Among the infectious diseases analyzed, CNS infection had the highest risk for PICU hospitalization, followed by UTI and LRTI.
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Affiliation(s)
- Judah Freedman
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Ruslan Sergienko
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amalia Levy
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Subhi R, Gelbart B, Ching N, Thompson J, Osowicki J, Rozen TH, Shanthikumar S, Teague W, Duke T. Characteristics, management and changing incidence of children with empyema in a paediatric intensive care unit. J Paediatr Child Health 2022; 58:1046-1052. [PMID: 35191560 PMCID: PMC9305239 DOI: 10.1111/jpc.15905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
AIM Paediatric intensive care unit (PICU) admissions for empyema increased following the 13-valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13. METHODS Retrospective study of patients <18 years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019. We investigated the incidence of empyema during two time periods: 2007-2010 (pre-PCV13) and 2016-2019 (post-PCV13). RESULTS Seventy-one children (1.9% of all PICU admissions) were admitted to PICU with empyema between 2016 and 2019. Sixty-one (86%) had unilateral disease, 11 (16%) presented with shock and 44 (62%) were ventilated. Streptococcus pneumoniae and group A Streptococcus were the most commonly identified pathogens. Forty-five (63%) were managed with video-assisted thoracoscopic surgery (VATS). There was a 31% reduction in empyema hospitalisations as a proportion of all hospitalisations (IRR 0.69, 95% CI 0.59-0.8), but a 2.8-fold increase in empyema PICU admissions as a proportion of all PICU admissions (95% CI 2.2-3.5, P < 0.001). For the PICU cohort, this was accompanied by reduction in PIM2 probability of death (median 1% vs. 1.9%, P = 0.02) and duration of intubation (median 69 h vs. 126.5 h, P = 0.045). CONCLUSIONS In children with empyema in PICU 62% required ventilation, 16% had features of shock and 63% received VATS. Empyema admissions, as a proportion of all PICU admissions, increased in the era post-PCV13 compared to pre-PCV13 despite no increase in illness severity at admission.
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Affiliation(s)
- Rami Subhi
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Ben Gelbart
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Natasha Ching
- Microbiology, Department of PathologyLaboratory ServicesMelbourneVictoriaAustralia,Infection and ImmunityMonash Children's HospitalMelbourneVictoriaAustralia,General PaediatricsMonash Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Jenny Thompson
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Joshua Osowicki
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Thomas H Rozen
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Shivanthan Shanthikumar
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Respiratory and Sleep MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Warwick Teague
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Clinical SciencesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Paediatric Surgery, Trauma ServiceRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Trevor Duke
- Paediatric Intensive Care UnitRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Discipline of Child Health, School of Medicine and Health SciencesUniversity of Papua New GuineaPort MoresbyPapua New Guinea
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