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Fan C, Mao Y, Liu J, Gao H, Fang B, Li R, Liu G, He Y, Qian S. Dynamics of platelet parameters in children with severe community-acquired pneumonia between viral and bacterial infections. Transl Pediatr 2024; 13:52-62. [PMID: 38323174 PMCID: PMC10839274 DOI: 10.21037/tp-23-441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024] Open
Abstract
Background Changes in platelet parameters may vary according to the different pathogens. However, little is known about the differences in platelet parameters in children with severe community-acquired pneumonia (CAP) children of viral and bacterial infections. Methods This was a single-center retrospective study that included 156 children with severe CAP. Dynamic changes in platelet parameters, including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT), were recorded at 24 h, 48 h, 72 h, and day 7 of admission, as well as at discharge. Results At 72 h of admission, PLT in the viral infection group was significantly lower than that in the bacterial infection and bacterial and viral coinfections group. Meanwhile, the curve of changes in PLT (ΔPLT) in the viral infection group was clearly separated from the other two groups at this time point. Receiver operating characteristic (ROC) analysis showed that PLT at 72 h of admission could assist in distinguishing bacterial and viral infections in severe pneumonia children with the area under curve (AUC) value of 0.683 [95% confidence interval (CI): 0.561-0.805, P=0.007]. However, its sensitivity and specificity were not high, at 68% and 65%, respectively. Conclusions Although the diagnostic value of platelet parameters in bacterial and viral infection in children with severe CAP is limited, they are still expected to be combined with other indicators to provide a reference for timely treatment.
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Affiliation(s)
- Chaonan Fan
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yiyang Mao
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jun Liu
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Hengmiao Gao
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Boliang Fang
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Rubo Li
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Gang Liu
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yushan He
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Suyun Qian
- Department of Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, China
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Tran XD, Hoang VT, Goumballa N, Vu TN, Tran TK, Pham TD, Dao TL, Vu TT, Nguyen DC, Nguyen QT, Marty P, Gautret P. Viral and bacterial microorganisms in Vietnamese children with severe and non-severe pneumonia. Sci Rep 2024; 14:120. [PMID: 38167637 PMCID: PMC10761988 DOI: 10.1038/s41598-023-50657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
To investigate potential respiratory pathogens in children with community-acquired pneumonia (CAP) and risk factors for severe disease. This prospective study was conducted among 467 children at the Thai Binh Paediatric Hospital, Vietnam between 1 July 2020 and 30 June 2021. Clinical data and laboratory results were collected. Twenty-four respiratory microorganisms were tested from nasopharyngeal swabs using real-time PCR. Logistical regression was used to estimate a factor's adjusted odd ratios of the severity of disease. Mean age of patients = 15.4 ± 13.3 months, 63.0% were male. Over 97% of patients had a positive PCR result. 87% of patients were positive for multiple (up to eight) microorganisms. Rhinovirus (46%), respiratory syncytial virus (RSV) (24%), enterovirus (17%), and parainfluenza viruses-3 (13%) were the most frequent viruses. H. influenzae (61%), S. pneumoniae (45%) and M. catarrhalis (30%) were the most common bacteria. 128 (27%) cases were classified as severe pneumonia. Presence of smokers at home (aOR 2.11, 95% CI 1.27-3.52, P value = 0.004), CRP level ≥ 50 mg/dL (aOR 6.11, 95% CI 3.86-9.68, P value < 0.0001), RSV (aOR 1.78, 95% CI 1.07-2.96, P value = 0.03) and H. influenzae (aOR 1.66, 95% CI 1.03-2.67, P value = 0.04) PCR detection associated with a higher risk of severe pneumonia; ,. Causative agents of pneumonia in children are complex. Children positive with RSV and H. influenzae need to be closely monitored to prevent severe pneumonia.
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Affiliation(s)
- Xuan Duong Tran
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, Marseille, France
| | - Van-Thuan Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ndiaw Goumballa
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
| | | | | | - Thi Dung Pham
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi-Loi Dao
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Thi Thuy Vu
- Thai Binh Paediatric Hospital, Thai Binh, Vietnam
| | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Quoc Tien Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Pierre Marty
- Inserm, C3M, Université Côte d'Azur, Nice Cedex 3, France
- Parasitologie-Mycologie, Centre Hospitalier Universitaire l'Archet, Nice Cedex 3, France
| | - Philippe Gautret
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam.
- Institut Hospitalo-Universitaire (IHU)-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
- IRD, AP-HM, SSA, VITROME, Aix Marseille University, Marseille, France.
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Cai L, Zuo X, Ma L, Zhang Y, Xu F, Lu B. Associations of MMP9 polymorphism with the risk of severe pneumonia in a Southern Chinese children population. BMC Infect Dis 2024; 24:19. [PMID: 38166679 PMCID: PMC10763005 DOI: 10.1186/s12879-023-08931-4] [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: 04/12/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Severe pneumonia frequently causes irreversible sequelae and represents a major health burden for children under the age of 5. Matrix Metallopeptidase 9 (MMP9) is a zinc-dependent endopeptidase that is involved in various cellular processes. The correlation between MMP9 and the risk of severe childhood pneumonia remains unclear. METHODS Here we assemble a case-control cohort to study the association of genetic variants in MMP9 gene with severe childhood pneumonia susceptibility in a Southern Chinese population (1034 cases and 8426 controls). RESULTS Our results indicate that the allele G in rs3918262 SNP was significantly associated with an increased risk of severe pneumonia. Bioinformatic analyses by expression quantitative trait loci (eQTL), RegulomeDB and FORGEdb database analysis showed that rs3918262 SNP has potential regulatory effect on translational efficiency and protein level of MMP9 gene. Furthermore, MMP9 concentrations were significantly up-regulated in the bronchoalveolar lavages (BALs) of children with severe pneumonia. CONCLUSION In summary, our findings suggest that MMP9 is a novel predisposing gene for childhood pneumonia.
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Affiliation(s)
- Li Cai
- Department of Hospital Infection Control, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510120, China
| | - Xiaoyu Zuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Liuheyi Ma
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Yuxia Zhang
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China
| | - Falin Xu
- Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052, China.
| | - Bingtai Lu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, China.
- Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University Guangzhou, Guangzhou, Guangdong, 510080, China.
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Tran-Quang K, Nguyen-Thi-Dieu T, Tran-Do H, Pham-Hung V, Nguyen-Vu T, Tran-Xuan B, Larsson M, Duong-Quy S. Antibiotic resistance of Streptococcus pneumoniae in Vietnamese children with severe pneumonia: a cross-sectional study. Front Public Health 2023; 11:1110903. [PMID: 37383272 PMCID: PMC10294427 DOI: 10.3389/fpubh.2023.1110903] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/25/2023] [Indexed: 06/30/2023] Open
Abstract
Background Streptococcus pneumoniae is the most common bacterium that causes community-acquired pneumonia (CAP) in children. The rate of S. pneumoniae resistance to antibiotics is increasing, particularly in patients with severe CAP. Therefore, the level of antibiotic resistance of S. pneumoniae causing severe CAP in Vietnamese children requires regular monitoring. Methods This was a cross-sectional descriptive study. Nasopharyngeal aspiration specimens from children were cultured, isolated, and examined for S. pneumoniae. Bacterial strains were assessed for antimicrobial susceptibility, and the minimum inhibitory concentration (MIC) was determined. Results Eighty-nine strains of S. pneumoniae were isolated from 239 children with severe CAP. The majority of isolates were completely non-susceptible to penicillin (1.1% intermediate, 98.9% resistant) and highly resistant to erythromycin (96.6%) and clarithromycin (88.8%); the rate of resistance to ceftriaxone was 16.9%, with the proportion of intermediate resistance at 46.0%; 100% of strains were susceptible to vancomycin and linezolid. For most antibiotics, MIC50 and MIC90 were equal to the resistance threshold according to the Clinical and Laboratory Standards Institute 2021; penicillin had an eight-fold increase in MIC90 (64 mg/L) and ceftriaxone had a 1.5-fold increase in MIC90 (6 mg/L). Conclusion Streptococcus pneumoniae isolates described in this study were resistant to many antibiotics. Penicillin should not be the first-line antibiotic of choice, and ceftriaxone at an enhanced dose should be used instead.
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Affiliation(s)
- Khai Tran-Quang
- Department of Paediatrics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | | | - Hung Tran-Do
- Department of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Van Pham-Hung
- International Research of Gene and Immunology Institute, Laboratory of Nam Khoa Biotek Company, Ho Chi Minh City, Vietnam
| | - Trung Nguyen-Vu
- Department of Microbiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bach Tran-Xuan
- Department of Health Economics, Institute of Health Economics and Technology, Hanoi Medical University, Hanoi, Vietnam
| | - Mattias Larsson
- Global Public Health Department, Karolinska Institutet, Stockholm, Sweden
| | - Sy Duong-Quy
- Biomedical Research Center, Lam Dong Medical College, Dalat, Vietnam
- Division of Immuno-Allergology and Pulmonology, Penn State Medical College, Hershey Medical Center, Hershey, PA, United States
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Zheng Y, Shi C, Han Y, Li X, Dong L, Li Y, Chen H, Wang Y, Li J, Liu G, Ma R, Lian F, Tong X. Efficacy and safety of a Chinese herbal formula Maxing Ganshi Decoction in children with community-acquired pneumonia: A randomized, double-blind, placebo-controlled, multicenter trial. Front Pharmacol 2022; 13:948831. [PMID: 36120338 PMCID: PMC9479123 DOI: 10.3389/fphar.2022.948831] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background: As one of the most commonly used Chinese medicine formula in the manage of respiratory diseases, Maxing Ganshi Decoction (MGD) has been demonstrated to improve the clinical symptoms of pneumonia. To evaluate the efficacy and safety of MGD in treating children with community-acquired pneumonia (CAP), we conducted the clinical trial.Methods: A randomized, double-blind, placebo-controlled, multicenter trial was conducted in 3 study sites in Tianjin, China. MDG or placebo were randomly given to patients aged 3–6 years with onset of CAP within 48 h. Changes in disease efficacy during the study period (which was measured as recovery, significant effect, improvement and no effect) was evaluated as the primary outcome. Time from enrollment to fever resolution was assessed as the secondary outcome. The adverse event was analyzed as safety evaluation.Results: A total of 71 patients (36 in MGD and 35 in placebo) were randomized and completed the whole study. The patient demographics and other characteristics at baseline were similar between the 2 groups (p > 0.05). After 10 days of intervention, the proportion of recovered and significant effective patients was increased significantly in the MGD group (34.85% [95% CI, 12.44%–57.26%]; p < 0.05) compared with the control group. Besides, the symptom score of the MGD group was lowered significantly (p < 0.001). The estimated time to fever resolution in the MGD group was also reduced compared with the control group (p < 0.05). During the whole study, no side effects were observed in both MGD and control groups.Conclusion: MGD was effective in improving disease efficacy, clinical symptoms and reducing time to fever resolution in patients with childhood CAP, which suggested that MGD may be used as an alternative therapy in the treatment of childhood CAP.Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=5612, identifier 13003955.
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Affiliation(s)
- Yujiao Zheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- College of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Changren Shi
- The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yaowei Han
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinmin Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lijing Dong
- Binhai New Area Hangu Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Yan Li
- Binhai New Area Hangu Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Hui Chen
- Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yushui Wang
- Tianjin Hospital of ITCWM Nankai Hospital, Tianjin, China
| | - Jinsong Li
- Tianjin Union Medical Center Affiliated to Nankai University, Tianjin, China
| | - Geli Liu
- Tianjin Medical University General Hospital, Tianjin, China
| | - Rong Ma
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Rong Ma, ; Fengmei Lian, ; Xiaolin Tong,
| | - Fengmei Lian
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Rong Ma, ; Fengmei Lian, ; Xiaolin Tong,
| | - Xiaolin Tong
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Rong Ma, ; Fengmei Lian, ; Xiaolin Tong,
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Guo W, Cui X, Wang Q, Wei Y, Guo Y, Zhang T, Zhan J. Clinical evaluation of metagenomic next-generation sequencing for detecting pathogens in bronchoalveolar lavage fluid collected from children with community-acquired pneumonia. Front Med (Lausanne) 2022; 9:952636. [PMID: 35911412 PMCID: PMC9334703 DOI: 10.3389/fmed.2022.952636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023] Open
Abstract
This study is to evaluate the usefulness of pathogen detection using metagenomic next-generation sequencing (mNGS) on bronchoalveolar lavage fluid (BALF) specimens from children with community-acquired pneumonia (CAP). We retrospectively collected BALF specimens from 121 children with CAP at Tianjin Children's Hospital from February 2021 to December 2021. The diagnostic performances of mNGS and conventional tests (CT) (culture and targeted polymerase chain reaction tests) were compared, using composite diagnosis as the reference standard. The results of mNGS and CT were compared based on pathogenic and non-pathogenic organisms. Pathogen profiles and co-infections between the mild CAP and severe CAP groups were also analyzed. The overall positive coincidence rate was 86.78% (105/121) for mNGS and 66.94% (81/121) for CT. The proportion of patients diagnosed using mNGS plus CT increased to 99.18%. Among the patients, 17.36% were confirmed only by mNGS; Streptococcus pneumoniae accounted for 52.38% and 23.8% of the patients were co-infected. Moreover, Bordetella pertussis and Human bocavirus (HBoV) were detected only using mNGS. Mycoplasma pneumoniae, which was identified in 89 (73.55%) of 121 children with CAP, was the most frequent pathogen detected using mNGS. The infection rate of M. pneumoniae in the severe CAP group was significantly higher than that in the mild CAP group (P = 0.007). The symptoms of single bacterial infections (except for mycoplasma) were milder than those of mycoplasma infections. mNGS identified more bacterial infections when compared to the CT methods and was able to identify co-infections which were initially missed on CT. Additionally, it was able to identify pathogens that were beyond the scope of the CT methods. The mNGS method is a powerful supplement to clinical diagnostic tools in respiratory infections, as it can increase the precision of diagnosis and guide the use of antibiotics.
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Affiliation(s)
- Wei Guo
- Clinical School of Paediatrics, Tianjin Medical University, Tianjin, China
- Department of Respiratory Medicine, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Xiaojian Cui
- Department of Clinical Lab, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Qiushi Wang
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
| | - Yupeng Wei
- Department of Respiratory Medicine, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Yanqing Guo
- Infection Business Unit, Tianjin Novogene Med LAB Co., Ltd., Tianjin, China
- *Correspondence: Yanqing Guo
| | - Tongqiang Zhang
- Clinical School of Paediatrics, Tianjin Medical University, Tianjin, China
- Department of Respiratory Medicine, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
- Tongqiang Zhang
| | - Jianghua Zhan
- Clinical School of Paediatrics, Tianjin Medical University, Tianjin, China
- Department of Pediatric Surgery, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
- Jianghua Zhan
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Vitamin K3 inhibits FtsZ assembly, disrupts the Z-ring in Streptococcus pneumoniae, and displays anti-pneumococcal activity. Biochem J 2022; 479:1543-1558. [PMID: 35789252 DOI: 10.1042/bcj20220077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
The respiratory pathogen, Streptococcus pneumoniae has acquired multiple-drug resistance over the years. An attractive strategy to combat pneumococcal infection is to target cell division to inhibit the proliferation of S. pneumoniae. This work presents Vitamin K3 as a potential anti-pneumococcal drug that targets FtsZ, the master coordinator of bacterial cell division. Vitamin K3 strongly inhibited S. pneumoniae proliferation with a Minimum Inhibitory Concentration (MIC) and a Minimum Bactericidal Concentration (MBC) of 6 μg/mL. Vitamin K3 disrupted the Z-ring localization in both S. pneumoniae and Bacillus subtilis within 30 minutes of treatment, while the membrane integrity and nucleoid segregation remain unchanged. Several complementary experiments showed that Vitamin K3 inhibits the assembly of purified S. pneumoniae FtsZ (SpnFtsZ) and induces conformational changes in the protein. Interestingly, Vitamin K3 interfered with GTP-binding onto FtsZ and increased the GTPase activity of FtsZ polymers. The intrinsic tryptophan fluorescence of SpnFtsZ revealed that Vitamin K3 delays the nucleation of FtsZ polymers and reduces the rate of polymerization. In the presence of a non-hydrolyzable analog of GTP, Vitamin K3 did not show inhibition of FtsZ polymerization. These results indicated that Vitamin K3 induces conformational changes in FtsZ that increase GTP hydrolysis and thereby, destabilize the FtsZ polymers. Together, our data provide evidence that Vitamin K3 derives its potent anti-pneumococcal activity by inhibiting FtsZ assembly.
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Intestinal Flora: A Potential Mechanism by Which Yinlai Decoction Treats Lipopolysaccharide-Induced Pneumonia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3034714. [PMID: 35368748 PMCID: PMC8967558 DOI: 10.1155/2022/3034714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/16/2022] [Accepted: 01/30/2022] [Indexed: 11/17/2022]
Abstract
Background. We intended to explore the mechanism of Yinlai decoction in the treatment of lipopolysaccharide (LPS)-induced pneumonia from the perspective of intestinal flora. Methods. Thirty Sprague–Dawley rats were randomly assigned to the blank control group (N), the pneumonia group (P), and the Yinlai decoction group (PT). The rat pneumonia model was established using LPS inhalation (0.5 mg/mL, 5 mL, 30 min/day, 3 days). Yinlai decoction was administered intragastrically (2 mL/100 g, 3 days). Lung tissue pathology, organ indexes, serum inflammatory factors, tumor necrosis factor-alpha (TNF-α), and intestinal flora changes were measured. Results. Lung tissue inflammation was prevented by Yinlai decoction. IL-6 levels showed a higher tendency to be higher, and IL-12 and TNF-α were significantly higher in the PT group than in the P group. The structure of the intestinal flora in the P differed from that in the N. The relative abundance of 10 out of 12 microflora was significantly higher in the P group than in the N and PT groups. In the PT group, the structure and the distribution of microbial groups were like those of the N group. Conclusions. Yinlai decoction inhibited LPS-induced lung and systemic inflammation in rats and may help the intestinal flora restore equilibrium by inhibiting the colonization of pathogenic bacteria and adjusting the ratio between probiotics and pathogenic bacteria. Intestinal flora may serve as a mediator of Yinlai decoction’s effect on LPS-induced pneumonia.
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Chen VCH, Kao KL, Chen YL, Wu SI, Lee MJ, Gossop M. Methylphenidate Use and Infectious Diseases in Children With Attention Deficit and Hyperactivity Disorder: A Population-Based Study. Front Med (Lausanne) 2022; 8:787745. [PMID: 35211484 PMCID: PMC8861374 DOI: 10.3389/fmed.2021.787745] [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: 10/01/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Children with attention deficit hyperactivity disorder (ADHD) have more visits to the emergency department (ED) due to injuries than those without ADHD. However, no study has investigated whether children with ADHD have more ED visits or hospitalizations due to infectious diseases (IDs) and whether methylphenidate (MPH) treatment may reduce the risk. Method The incidence of ID-related ED visits or hospitalizations was defined as the main outcome. The Cox regression and conditional Poisson regression models were calculated to estimate hazard ratios (HRs) in the population level and relative risks for the self-controlled case series design, respectively. Results Children with ADHD had higher rates of emergency visits (HR = 1.25, 95% CI: 1.23~1.27) and hospitalizations (HR = 1.28, 95% CI: 1.26~1.31) due to IDs than those without ADHD. In the ADHD subgroup, those who received MPH treatment have a reduced risk of emergency visits (HR = 0.10, 95% CI: 0.09~0.10) and hospitalizations (HR = 0.73, 95% CI: 0.71~0.75), compared to those without treatment. The risk of ID-related emergency visits decreased to 0.21 (95% CI: 0.21~0.22); and hospitalizations decreased to 0.71 (95% CI: 0.69~0.73). Within self-controlled analysis, it is demonstrated that compared with non-MPH exposed period, children with ADHD had significantly decreased risks for infection-related emergency visits (RR = 0.73, 95% CI: 0.68~0.78) or hospitalizations (RR = 0.19, 95% CI: 0.17~0.21) during MPH-exposed periods. Conclusions and Relevance This is the first study that reported an increased risk of ID-related healthcare utilizations in children with ADHD compared to those without, and that such risks may be significantly reduced in ADHD children that received MPH treatment.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Liang Kao
- Division of Infectious Diseases, Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Min-Jing Lee
- Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, King's College London, London, United Kingdom
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10
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Applications of mPCR testing reduced initial antibiotic use and duration of mechanical ventilation in virus-infected children with severe community-acquired pneumonia admitted to the PICU. World J Pediatr 2022; 18:449-452. [PMID: 35349105 PMCID: PMC8961260 DOI: 10.1007/s12519-022-00528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/15/2022] [Indexed: 11/02/2022]
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Buonsenso D, De Rose C. Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health? Eur J Pediatr 2022; 181:1-8. [PMID: 34216270 PMCID: PMC8254441 DOI: 10.1007/s00431-021-04179-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, Rome, Italy.
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
- Global Health Research Institute, Istituto Di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, Rome, Italy
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12
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Mathisen M, Basnet S, Christensen A, Sharma AK, Tylden G, Krokstad S, Valentiner-Branth P, Strand TA. Viral and Atypical Bacterial Detection in Young Nepalese Children Hospitalized with Severe Pneumonia. Microbiol Spectr 2021; 9:e0055121. [PMID: 34704788 PMCID: PMC8549725 DOI: 10.1128/spectrum.00551-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Respiratory viruses cause a substantial proportion of respiratory tract infections in children but are underrecognized as a cause of severe pneumonia hospitalization in low-income settings. We employed 22 real-time PCR assays and retrospectively reanalyzed 610 nasopharyngeal aspirate specimens from children aged 2 to 35 months with severe pneumonia (WHO definition) admitted to Kanti Childrens' Hospital in Kathmandu, Nepal, from January 2006 through June 2008. Previously, ≥1 of 7 viruses had been detected by multiplex reverse transcription-PCR in 30% (188/627) of cases. Reanalyzing the stored specimens, we detected ≥1 pathogens, including 18 respiratory viruses and 3 atypical bacteria, in 98.7% (602/610) of cases. Rhinovirus (RV) and respiratory syncytial virus (RSV) were the most common, detected in 318 (52.1%) and 299 (49%) cases, respectively, followed by adenovirus (AdV) (10.6%), human metapneumovirus (hMPV) (9.7%), parainfluenza virus type 3 (8.4%), and enterovirus (7.7%). The remaining pathogens were each detected in less than 5%. Mycoplasma pneumoniae was most common among the atypical bacteria (3.7%). Codetections were observed in 53.3% of cases. Single-virus detection was more common for hMPV (46%) and RSV (41%) than for RV (22%) and AdV (6%). The mean cycle threshold value for detection of each pathogen tended to be lower in single-pathogen detections than in codetections. This finding was significant for RSV, RV, and AdV. RSV outbreaks occurred at the end of the monsoon or during winter. An expanded diagnostic PCR panel substantially increased the detection of respiratory viruses in young Nepalese children hospitalized with severe pneumonia. IMPORTANCE Respiratory viruses are an important cause of respiratory tract infections in children but are underrecognized as a cause of pneumonia hospitalization in low-income settings. Previously, we detected at least one of seven respiratory viruses by PCR in 30% of young Nepalese children hospitalized with severe pneumonia over a period of 36 months. Using updated PCR assays detecting 21 different viruses and atypical bacteria, we reanalyzed 610 stored upper-respiratory specimens from these children. Respiratory viruses were detected in nearly all children hospitalized for pneumonia. RSV and rhinovirus were the predominant pathogens detected. Detection of two or more pathogens was observed in more than 50% of the pneumonia cases. Single-virus detection was more common for human metapneumovirus and RSV than for rhinovirus and adenovirus. The concentration of virus was higher (low cycle threshold [CT] value) for single detected pathogens, hinting at a high viral load as a marker of clinical significance.
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Affiliation(s)
- Maria Mathisen
- Department of Medical Microbiology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Sudha Basnet
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Andreas Christensen
- Department of Medical Microbiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Arun K. Sharma
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Garth Tylden
- Department of Microbiology and Infection control, University Hospital of North Norway, Tromsø, Norway
| | - Sidsel Krokstad
- Department of Medical Microbiology, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Palle Valentiner-Branth
- Statens Serum Institut, Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Copenhagen, Denmark
| | - Tor A. Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
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Francois Watkins LK, Milucky JL, McGee L, Siné St-Surin F, Liu P, Tran T, Chochua S, Joseph G, Shang N, Juin S, Dely P, Patel R, Van Beneden CA. Nasopharyngeal Carriage of Streptococcus pneumoniae Among Young Children in Haiti Before Pneumococcal Conjugate Vaccine Introduction. J Infect Dis 2021; 224:S248-S257. [PMID: 34469560 DOI: 10.1093/infdis/jiab119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae, or pneumococcus, is a leading cause of morbidity and mortality in children worldwide. Pneumococcal conjugate vaccines (PCV) reduce carriage in the nasopharynx, preventing disease. We conducted a pneumococcal carriage study to estimate the prevalence of pneumococcal colonization, identify risk factors for colonization, and describe antimicrobial susceptibility patterns among pneumococci colonizing young children in Port-au-Prince, Haiti, before introduction of 13-valent PCV (PCV13). METHODS We conducted a cross-sectional study of children aged 6-24 months at an immunization clinic in Port-au-Prince between September 2015 and January 2016. Consenting parents were interviewed about factors associated with pneumococcal carriage; nasopharyngeal swabs were collected from each child and cultured for pneumococcus after broth enrichment. Pneumococcal isolates were serotyped and underwent antimicrobial susceptibility testing. We compared frequency of demographic, clinical, and environmental factors among pneumococcus-colonized children (carriers) to those who were not colonized (noncarriers) using unadjusted bivariate analysis and multivariate logistic regression. RESULTS Pneumococcus was isolated from 308 of the 685 (45.0%) children enrolled. Overall, 157 isolates (50.8%) were PCV13 vaccine-type serotypes; most common were 6A (13.3%), 19F (12.6%), 6B (9.7%), and 23F (6.1%). Vaccine-type isolates were significantly more likely to be nonsusceptible to ≥1 antimicrobial (63.1% vs 45.4%, P = .002). On bivariate analysis, carriers were significantly more likely than noncarriers to live in a household without electricity or running water, to share a bedroom with ≥3 people, to have a mother or father who did not complete secondary education, and to have respiratory symptoms in the 24 hours before enrollment (P < .05 for all comparisons). On multivariable analysis, completion of the pentavalent vaccination series (targeting diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type b) remained significantly more common among noncarriers. CONCLUSIONS Nearly a quarter of healthy children surveyed in Haiti were colonized with vaccine-type pneumococcal serotypes. This baseline carriage study will enable estimation of vaccine impact following nationwide introduction of PCV13.
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Affiliation(s)
- Louise K Francois Watkins
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L Milucky
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lesley McGee
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Pengbo Liu
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Theresa Tran
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sopio Chochua
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerard Joseph
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Nong Shang
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stanley Juin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Patrick Dely
- Ministère de la Santé Publique et de la Population, Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - Roopal Patel
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti.,Global Fund to Fight AIDS, Tuberculosis, and Malaria, Grand-Saconnex, Switzerland
| | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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The Role of the Respiratory Microbiome and Viral Presence in Lower Respiratory Tract Infection Severity in the First Five Years of Life. Microorganisms 2021; 9:microorganisms9071446. [PMID: 34361882 PMCID: PMC8307314 DOI: 10.3390/microorganisms9071446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022] Open
Abstract
Lower respiratory tract infections (LRTIs) in children are common and, although often mild, a major cause of mortality and hospitalization. Recently, the respiratory microbiome has been associated with both susceptibility and severity of LRTI. In this current study, we combined respiratory microbiome, viral, and clinical data to find associations with the severity of LRTI. Nasopharyngeal aspirates of children aged one month to five years included in the STRAP study (Study to Reduce Antibiotic prescription in childhood Pneumonia), who presented at the emergency department (ED) with fever and cough or dyspnea, were sequenced with nanopore 16S-rRNA gene sequencing and subsequently analyzed with hierarchical clustering to identify respiratory microbiome profiles. Samples were also tested using a panel of 15 respiratory viruses and Mycoplasma pneumoniae, which were analyzed in two groups, according to their reported virulence. The primary outcome was hospitalization, as measure of disease severity. Nasopharyngeal samples were isolated from a total of 167 children. After quality filtering, microbiome results were available for 54 children and virology panels for 158 children. Six distinct genus-dominant microbiome profiles were identified, with Haemophilus-, Moraxella-, and Streptococcus-dominant profiles being the most prevalent. However, these profiles were not found to be significantly associated with hospitalization. At least one virus was detected in 139 (88%) children, of whom 32.4% had co-infections with multiple viruses. Viral co-infections were common for adenovirus, bocavirus, and enterovirus, and uncommon for human metapneumovirus (hMPV) and influenza A virus. The detection of enteroviruses was negatively associated with hospitalization. Virulence groups were not significantly associated with hospitalization. Our data underlines high detection rates and co-infection of viruses in children with respiratory symptoms and confirms the predominant presence of Haemophilus-, Streptococcus-, and Moraxella-dominant profiles in a symptomatic pediatric population at the ED. However, we could not assess significant associations between microbiome profiles and disease severity measures.
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Allin E, Nama N, Irvine MA, Pawliuk C, Wright M, Carwana M. Conservative and surgical modalities in the management of paediatric parapneumonic effusion and empyema: a protocol for a living systematic review and network meta-analysis. BMJ Open 2021; 11:e045010. [PMID: 33762243 PMCID: PMC7993311 DOI: 10.1136/bmjopen-2020-045010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Parapneumonic effusion and empyema are common complications of paediatric pneumonia. Acceptable treatment modalities for large parapneumonic effusions include antibiotics alone or in conjunction with surgical interventions. Clear guidelines on the best treatment approach are lacking and mostly based on evidence prior to widespread pneumococcal conjugate 13-valent vaccination (PCV-13). METHODS AND ANALYSIS A living systematic review and network meta-analysis will be performed comparing the five treatment modalities: (1) antibiotics alone; (2) chest tube drainage without fibrinolytics; (3) chest tube drainage with fibrinolytics; (4) video-assisted thoracoscopic surgery and (5) open thoracotomy. The review protocol is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Eligible studies are randomised controlled trials comparing any pair of interventions in paediatric patients with empyema or parapneumonic effusion. The following databases will be searched: Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, LILACS and Google Scholar. Citation screening and data extraction will be completed using a validated crowdsourcing methodology using InsightScope. To assess the risk of bias, we will use the revised Cochrane risk of bias tool for randomised trials. The primary outcome of the study is the length of stay. Secondary outcomes are (1) periprocedural complications and (2) need for re-intervention. A frequentist network meta-analysis design will be implemented with a random-effects model comparing different interventions. In a subgroup analysis, studies and patients will be stratified by the size of pleural effusion and the date of trial (pre/post-PCV-13). Eligible citations and available results will be uploaded to an online database, hosted on Open Science Framework. The database will be updated at least every 4 months with any newly published research. ETHICS AND DISSEMINATION No ethics review is required for this study. Results will be published in a peer-reviewed journal. Data will be available as part of an online database summarising the evidence of this living systematic review. PROSPERO REGISTRATION Pending peer review.
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Affiliation(s)
- Emily Allin
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Nassr Nama
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- Evidence to Innovation, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Colleen Pawliuk
- Evidence to Innovation, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Marie Wright
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Matthew Carwana
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of General Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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16
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Liu X, Zhao P, Ge W. Knockdown of circular RNA circZNF652 remits LPS-induced inflammatory damage by regulating miR-181a. Biofactors 2020; 46:1031-1040. [PMID: 31889339 DOI: 10.1002/biof.1606] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Infantile pneumonia (IP) is a usual disease in infants and young children. The function and underlying mechanism of circZNF652 on lipopolysaccharide (LPS)-triggered inflammatory damage in WI-38 cells were detected in this article. METHODS WI-38 cells were induced by dosages of LPS to construct inflammatory injury model. WI-38 cell viability and apoptosis were detected by CCK-8 assay and flow cytometry, respectively. CircZNF652 and miR-181a levels were changed and detected by cell transfection and qRT-PCR. The levels of apoptosis and JNK/p38 and NF-κB pathways-related proteins, as well as the level of Cox-2 were detected by western blot. Finally, the concentrations of inflammatory factors were detected by ELISA. RESULTS LPS induced inflammatory injury showing as notably decreased the viability, while increased the numbers of apoptotic cells, as well as the levels of apoptosis and inflammatory factors in a dose dependent way. Besides, LPS inducement remarkably enhanced the expression of circZNF652. However, knockdown of circZNF652 remitted LPS-triggered inflammatory damage and restrained NF-κB and JNK/p38 pathways. Moreover, circZNF652 knockdown promoted miR-181a expression. Whereas, miR-181a inhibition markedly relieved circZNF652 knockdown-induced impacts. CONCLUSION Knockdown of circZNF652 remitted LPS-triggered WI-38 cells inflammatory damage through deactivation of NF-κB and JNK/p38pathways by up-regulating miR-181a.
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Affiliation(s)
- Xiuxia Liu
- Department of Pediatrics, Jining No.1 People's Hospital, Jining, Shandong, China
| | - Peifeng Zhao
- Department of Pediatrics, Jining No.1 People's Hospital, Jining, Shandong, China
| | - Wang Ge
- Department of Family Planning Technial Service, Jining Maternal and Child Health Family Planning Service Center, Jining, Shandong, China
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17
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Assoni L, Milani B, Carvalho MR, Nepomuceno LN, Waz NT, Guerra MES, Converso TR, Darrieux M. Resistance Mechanisms to Antimicrobial Peptides in Gram-Positive Bacteria. Front Microbiol 2020; 11:593215. [PMID: 33193264 PMCID: PMC7609970 DOI: 10.3389/fmicb.2020.593215] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023] Open
Abstract
With the alarming increase of infections caused by pathogenic multidrug-resistant bacteria over the last decades, antimicrobial peptides (AMPs) have been investigated as a potential treatment for those infections, directly through their lytic effect or indirectly, due to their ability to modulate the immune system. There are still concerns regarding the use of such molecules in the treatment of infections, such as cell toxicity and host factors that lead to peptide inhibition. To overcome these limitations, different approaches like peptide modification to reduce toxicity and peptide combinations to improve therapeutic efficacy are being tested. Human defense peptides consist of an important part of the innate immune system, against a myriad of potential aggressors, which have in turn developed different ways to overcome the AMPs microbicidal activities. Since the antimicrobial activity of AMPs vary between Gram-positive and Gram-negative species, so do the bacterial resistance arsenal. This review discusses the mechanisms exploited by Gram-positive bacteria to circumvent killing by antimicrobial peptides. Specifically, the most clinically relevant genera, Streptococcus spp., Staphylococcus spp., Enterococcus spp. and Gram-positive bacilli, have been explored.
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Affiliation(s)
- Lucas Assoni
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Barbara Milani
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Marianna Ribeiro Carvalho
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Lucas Natanael Nepomuceno
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Natalha Tedeschi Waz
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Maria Eduarda Souza Guerra
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Thiago Rojas Converso
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - Michelle Darrieux
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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19
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Rodríguez-Fanjul J, Guitart C, Bobillo-Perez S, Balaguer M, Jordan I. Procalcitonin and lung ultrasound algorithm to diagnose severe pneumonia in critical paediatric patients (PROLUSP study). A randomised clinical trial. Respir Res 2020; 21:255. [PMID: 33032612 PMCID: PMC7543673 DOI: 10.1186/s12931-020-01476-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Background Lung ultrasound (LUS) in combination with a biomarker has not yet been studied. We propose a clinical trial where the primary aims are: 1. To assess whether an algorithm with LUS and procalcitonin (PCT) may be useful for diagnosing bacterial pneumonia; 2. To analyse the sensitivity and specificity of LUS vs chest X-ray (CXR). Methods/design A 3-year clinical trial. Inclusion criteria: children younger than 18 years old with suspected pneumonia in a Paediatric Intensive Care Unit. Patients will be randomised into two groups: Experimental Group: LUS will be performed as first lung image. Control Group: CXR will be performed as first pulmonary image. Patients will be classified according to the image and the PCT: a) PCT < 1 ng/mL and LUS/CXR are not suggestive of bacterial pneumonia (BN), no antibiotic will be prescribed; b) LUS/CXR are suggestive of BN, regardless of the PCT, antibiotic therapy is recommended; c) LUS/CXR is not suggestive of BN and PCT > 1 ng/mL, antibiotic therapy is recommended. Conclusion This algorithm will help us to diagnose bacterial pneumonia and to prescribe the correct antibiotic treatment. A reduction of antibiotics per patient, of the treatment length, and of the exposure to ionizing radiation and in costs is expected. Trial registration NCT04217980.
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Affiliation(s)
- Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Carmina Guitart
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Mònica Balaguer
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.
| | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Research Group. Institut de Recerca Sant Joan de Déu, CIBERESP, Barcelona, Spain
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Cai X, Xu Q, Zhou C, Zhou L, Yong Q, Mu Q, Cheng Y, Wang J, Xie J. Distribution characteristics of serum β2-microglobulin between viral and bacterial lower respiratory tract infections: a retrospective study. PeerJ 2020; 8:e9814. [PMID: 32904447 PMCID: PMC7453919 DOI: 10.7717/peerj.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is one of the leading cause of death in children under 5 years old around the world between 1980 and 2016. Distinguishing between viral and bacterial infection is challenging when children suffered from LRTI in the absence of pathogen detection. The aim of our study is to analyze the difference of serum β2-microglobulin (β2-MG) between viral LRTI and bacterial LRTI in children. METHODS This retrospective study included children with LRTI caused by a single pathogen from Yancheng Third People's Hospital, Yancheng, China, between January 1, 2016 and December 31, 2019. Participants were divided into the younger group (1 year old ≤ age < 3 years old) and the older group (3 years old ≤ age < 5 years old) for subgroup analysis. RESULTS A total of 475 children with LRTI caused by common respiratory pathogens were identified. In the younger group as well as the older group, the serum level of β2-MG in respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly increased compared to that in the Mycoplasma pneumoniae group. Compared with Streptococcus pneumoniae infection group, the serum β2-MG level of respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly higher in children between 1 and 3 years old. CONCLUSIONS The serum β2-MG may distinguish viral infection from bacterial infection in children with LRTI.
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Affiliation(s)
- Xulong Cai
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qiaolan Xu
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Chenrong Zhou
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Li Zhou
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qijun Yong
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qing Mu
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Yan Cheng
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Jiena Wang
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Jingjing Xie
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
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Converso TR, Assoni L, André GO, Darrieux M, Leite LCC. The long search for a serotype independent pneumococcal vaccine. Expert Rev Vaccines 2020; 19:57-70. [PMID: 31903805 DOI: 10.1080/14760584.2020.1711055] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Serotype replacement - a consequence of polysaccharide vaccine use - will continue to drive the inclusion of new serotypes on conjugate vaccines, increasing production complexity and costs, and making an already expensive vaccine less accessible to developing countries, where prevalence is higher and resources available for health systems, scarcer. Serotype-independent formulations are a promising option, but so far they have not been successful in reducing colonization/transmission.Areas covered: Protein-based and whole-cell vaccine candidates studied in the past 30 years. Challenges for serotype-independent vaccine development and alternative approaches.Expert opinion: Clinical trials performed so far demonstrated the importance to establish more reliable animal models and better correlates of protection. Defining appropriate endpoints for clinical trials of serotype-independent vaccine candidates has been a challenge. Inhibition of colonization has been evaluated, but concern on the extent of bacterial elimination is still a matter of debate. Challenges on establishing representative sites for clinical trials, sample sizes and appropriate age groups are discussed. On a whole, although many challenges will have to be overcome, establishing protein-based antigens as serotype-independent vaccines is still the best alternative against the huge burden of pneumococcal diseases in the world.
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Affiliation(s)
- T R Converso
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - L Assoni
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - G O André
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - M Darrieux
- Laboratório de Biologia Molecular de Microrganismos, Universidade São Francisco, Bragança Paulista, Brazil
| | - L C C Leite
- Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, São Paulo, SP, Brazil
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22
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van de Maat JS, Peeters D, Nieboer D, van Wermeskerken AM, Smit FJ, Noordzij JG, Tramper-Stranders G, Driessen GJA, Obihara CC, Punt J, van der Lei J, Polinder S, Moll HA, Oostenbrink R. Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial. PLoS Med 2020; 17:e1003034. [PMID: 32004317 PMCID: PMC6993966 DOI: 10.1371/journal.pmed.1003034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Optimising the use of antibiotics is a key component of antibiotic stewardship. Respiratory tract infections (RTIs) are the most common reason for antibiotic prescription in children, even though most of these infections in children under 5 years are viral. This study aims to safely reduce antibiotic prescriptions in children under 5 years with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule. METHODS AND FINDINGS In a stepped-wedge cluster randomised trial, we included children aged 1-60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. The EDs were of varying sizes, from diverse geographic and demographic regions, and of different hospital types (tertiary versus general). In the pre-intervention phase, children received usual care, according to the Dutch and NICE guidelines for febrile children. During the intervention phase, a validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein (CRP) was implemented as a decision rule guiding antibiotic prescription. The intervention was that antibiotics were withheld in children with a low or intermediate predicted risk of bacterial pneumonia (≤10%, based on Feverkidstool). Co-primary outcomes were antibiotic prescription rate and strategy failure. Strategy failure was defined as secondary antibiotic prescriptions or hospitalisations, persistence of fever or oxygen dependency up to day 7, or complications. Hospitals were randomly allocated to 1 sequence of treatment each, using computer randomisation. The trial could not be blinded. We used multilevel logistic regression to estimate the effect of the intervention, clustered by hospital and adjusted for time period, age, sex, season, ill appearance, and fever duration; predicted risk was included in exploratory analysis. We included 999 children (61% male, median age 17 months [IQR 9 to 30]) between 1 January 2016 and 30 September 2018: 597 during the pre-intervention phase and 402 during the intervention phase. Most children (77%) were referred by a general practitioner, and half of children were hospitalised. Intention-to-treat analyses showed that overall antibiotic prescription was not reduced (30% to 25%, adjusted odds ratio [aOR] 1.07 [95% CI 0.57 to 2.01, p = 0.75]); strategy failure reduced from 23% to 16% (aOR 0.53 [95% CI 0.32 to 0.88, p = 0.01]). Exploratory analyses showed that the intervention influenced risk groups differently (p < 0.01), resulting in a reduction in antibiotic prescriptions in low/intermediate-risk children (17% to 6%; aOR 0.31 [95% CI 0.12 to 0.81, p = 0.02]) and a non-significant increase in the high-risk group (47% to 59%; aOR 2.28 [95% CI 0.84 to 6.17, p = 0.09]). Two complications occurred during the trial: 1 admission to the intensive care unit during follow-up and 1 pleural empyema at day 10 (both unrelated to the study intervention). Main limitations of the study were missing CRP values in the pre-intervention phase and a prolonged baseline period due to logistical issues, potentially affecting the power of our study. CONCLUSIONS In this multicentre ED study, we observed that a clinical decision rule for childhood pneumonia did not reduce overall antibiotic prescription, but that it was non-inferior to usual care. Exploratory analyses showed fewer strategy failures and that fewer antibiotics were prescribed in low/intermediate-risk children, suggesting improved targeting of antibiotics by the decision rule. TRIAL REGISTRATION Netherlands Trial Register NTR5326.
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Affiliation(s)
- Josephine S. van de Maat
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Daphne Peeters
- Department of Paediatrics, HAGA–Juliana Children’s Hospital, Den Haag, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J. Smit
- Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Jeroen G. Noordzij
- Department of Paediatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | | | - Charlie C. Obihara
- Department of Paediatrics, Elisabeth–TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Jeanine Punt
- Department of Paediatrics, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A. Moll
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
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Nuttall JJC. Current antimicrobial management of community-acquired pneumonia in HIV-infected children. Expert Opin Pharmacother 2019; 20:595-608. [PMID: 30664362 DOI: 10.1080/14656566.2018.1561864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Community-acquired pneumonia is a leading cause of morbidity and mortality amongst HIV-infected infants and children. Polymicrobial infection is common and, due to the difficulties in confirming the etiology of pneumonia, empiric broad-spectrum antimicrobial therapy is frequently used. AREAS COVERED The author based this article on literature identified from PubMed. The author's search terms included: pneumonia, community-acquired pneumonia, HIV, children. The articles reviewed included original studies, recent review articles and current guidelines on the management of pneumonia in HIV-infected children. The microbiological etiology and the empiric and pathogen-specific antimicrobial therapy of community-acquired pneumonia in HIV-infected and HIV-exposed infants and children are also discussed. EXPERT OPINION There are many changing epidemiological factors impacting antimicrobial management of community-acquired pneumonia in the context of HIV infection in infants and children. These include vaccination strategies, antimicrobial prophylaxis, emerging drug-resistant pathogens, and recognition of the importance of viruses and tuberculosis in the etiology of community-acquired pneumonia. Further research is needed on optimal amtimicrobial management strategies in HIV-exposed uninfected children, and HIV-infected children receiving antiretroviral therapy.
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Affiliation(s)
- James J C Nuttall
- a Department of Paediatrics and Child Health, Faculty of Health Sciences , University of Cape Town and Red Cross War Memorial Children's Hospital , Cape Town , South Africa
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Nascimento-Carvalho AC, Nascimento-Carvalho CM. Clinical management of community-acquired pneumonia in young children. Expert Opin Pharmacother 2018; 20:435-442. [DOI: 10.1080/14656566.2018.1552257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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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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Treatment of Community-Acquired Pneumonia: Are All Countries Treating Children in the Same Way? A Literature Review. Int J Pediatr 2017; 2017:4239268. [PMID: 29234355 PMCID: PMC5694995 DOI: 10.1155/2017/4239268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/08/2017] [Indexed: 01/20/2023] Open
Abstract
Background Pneumonia represents an important threat to children's health in both developed and developing countries. In the last 10 years, many national and international guidelines on the treatment of pediatric CAP have been published, in order to optimize the prescription of antibiotics and limit their cost and side effects. However, the practical implementation of these guidelines is still limited. Main Text We analyzed the current recommendations for the therapy of pediatric community-acquired pneumonia (CAP) that all converge on the identification of aminopenicillins and beta-lactams as the optimal treatment for CAP. We also conducted a review of the current literature on antibiotic regimens used for pediatric CAP to identify the current state of guidelines implementation in different settings. We selected 37 studies published from 2010 to 2016, including both retrospective and prospective studies, mainly cross-sectional and hospital based. The results show a global heterogeneity in the antibiotics prescription for pediatric CAP, with application of guidelines varying from 0% to more than 91% and with important differences even within the same country. Conclusions Our review has demonstrated that the implementation of the guidelines is still limited but also that achieving the optimal prescription is possible and can be done in both developed and developing countries.
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