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Wu J, Zhang Y, Duan J, Wei Y, Miao Y. A metagenomic next-generation sequencing (mNGS)-based analysis of bronchoalveolar lavage samples in patients with an acute exacerbation of chronic obstructive pulmonary disease. J Mol Histol 2024:10.1007/s10735-024-10225-1. [PMID: 39060894 DOI: 10.1007/s10735-024-10225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
The role of the bronchoalveolar lavage fluid (BALF) microbiome in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) remains unclear. The advent of the metagenomic next-generation sequencing (mNGS) has made it possible to reveal the complex microbiome composition of the respiratory tract. This study aimed to explore whether there are differences in the BALF microbiome of AECOPD patients with different lung functions. We enrolled 55 AECOPD patients and divided them into a mild group (n = 31) and a severe group (n = 24) according to their lung function. We collected BALF and submitted it to mNGS and bioinformatics analysis. At the species level, mNGS identified 264 bacteria, 13 fungi and 12 viruses in the mild group, and 174 bacteria, 6 fungi and 6 viruses in the severe group. Mixed bacterial and viral infection occurred in both groups. At the genus level, Rothia and Veillonella were more abundant in the mild group, while Pseudomonas and Staphylococcus were more abundant in the severe group. At the species level, compared with the mild group, the relative abundance of Haemophilus influenzae and Pseudomonas aeruginosa was increased in the severe group. Besides, the BALF microbiome composition was similar between the two groups, and there was no significant difference in α and β diversity. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) (%) showed no significant correlation with the Shannon or Simpson index. The microbiome abundance was different between the mild and severe groups; however, microbiome diversity was similar between the two groups. Based on our findings, Haemophilus influenzae and Pseudomonas aeruginosa may be the pathogenic bacteria that cause the difference in lung function in patients with AECOPD.
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Affiliation(s)
- Junfang Wu
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, NO.256, Friendship West Road, Beilin District, Xi'an, 710068, Shaanxi, China
| | - Yongqing Zhang
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, NO.256, Friendship West Road, Beilin District, Xi'an, 710068, Shaanxi, China
| | - Jinjin Duan
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, NO.256, Friendship West Road, Beilin District, Xi'an, 710068, Shaanxi, China
| | - Yiqun Wei
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, NO.256, Friendship West Road, Beilin District, Xi'an, 710068, Shaanxi, China
| | - Yi Miao
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, NO.256, Friendship West Road, Beilin District, Xi'an, 710068, Shaanxi, China.
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2
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Mahtab S, Blau DM, Madewell ZJ, Ogbuanu I, Ojulong J, Lako S, Legesse H, Bangura JS, Bassat Q, Mandomando I, Xerinda E, Fernandes F, Varo R, Sow SO, Kotloff KL, Tapia MD, Keita AM, Sidibe D, Onyango D, Akelo V, Gethi D, Verani JR, Revathi G, Scott JAG, Assefa N, Madrid L, Bizuayehu H, Tirfe TT, El Arifeen S, Gurley ES, Islam KM, Alam M, Zahid Hossain M, Dangor Z, Baillie VL, Hale M, Mutevedzi P, Breiman RF, Whitney CG, Madhi SA. Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:201-213. [PMID: 38281495 PMCID: PMC10864189 DOI: 10.1016/s2352-4642(23)00328-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sandra Lako
- Aberdeen Women's Centre, Freetown, Sierra Leone
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain; Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Diakaridia Sidibe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Dickson Gethi
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Bizuayehu
- Department of Microbiology, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
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Baranov AA, Kozlov RS, Namazova-Baranova LS, Andreeva IV, Bakradze MD, Vishneva EA, Karaseva MS, Kuznetsova TA, Kulichenko TV, Lashkova YS, Lyutina EI, Manerov FK, Mayanskiy NA, Platonova MM, Polyakova AS, Selimzyanova LR, Tatochenko VK, Starovoytova EV, Stetsiouk OU, Fedoseenko MV, Chashchina IL, Kharkin AV. Modern approaches at the management of children with community-acquired pneumonia. PEDIATRIC PHARMACOLOGY 2023. [DOI: 10.15690/pf.v20i1.2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Experts of The Union of Pediatricians of Russia have developed current clinical guidelines for management of children with community-acquired pneumonia, which were approved by the Scientific and Practice Council of Ministry of Public Health of the Russian Federation in January 2022. Particular attention is paid to the etiological structure, modern classification, diagnostic tests and flagship approaches to antibacterial therapy of community-acquired pneumonia in children based on the principles of evidentiary medicine.
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Affiliation(s)
- Aleksander A. Baranov
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | - Elena A. Vishneva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | - Mariya S. Karaseva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - Yulia S. Lashkova
- Pirogov Russian National Research Medical University;
National Medical Research Center of Children’s Health
| | | | | | | | - Mariya M. Platonova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | - Lilia R. Selimzyanova
- Sechenov First Moscow State Medical University;
Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
| | | | | | | | - Marina V. Fedoseenko
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery;
Pirogov Russian National Research Medical University
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de Vasconcelos MGGC, Jarovsky D, Nunes GZ, Tridente DM, Grill JAT, Berezin EN. Molecular diagnostic of complicated pneumonia in the post-vaccine era. J Trop Pediatr 2022; 68:6760802. [PMID: 36228307 DOI: 10.1093/tropej/fmac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND The etiological diagnosis of community-acquired pneumonia (CAP) is still a challenge. We compared the conventional culture method and real-time polymerase chain reaction (RT-PCR) for the identification of Streptococcus pneumoniae in severe pediatric CAP. METHODS A retrospective hospital-based study was conducted. From 2012 to 2018, we have selected patients who had peripheral blood and/or pleural fluid collected for etiological investigation by RT-PCR. RESULTS We included 113 children (median age: 3 years; interquartile range 1-6 years). RT-PCR increased the detection rate of S. pneumoniae by 6.5 times using blood samples and eight times using pleural fluid samples. Patients subjected to RT-PCR showed more prolonged hospitalization (p = 0.006), fewer comorbidities (p = 0.03), presence of pleural effusion (p = 0.001), presence of young forms of leukocytes (p = 0.001) and radiograph with characteristics of pneumonia (p = 0.002). The presence of pleural effusion [odds ratio (OR) = 14.7, 95% confidence interval (CI) 1.6-133.9; p = 0.01] and young forms of leukocytes (OR = 8.9, 95% CI 0.9-84.4; p = 0.05) were risk factors for positive RT-PCR pneumococcal when multivariate analysis was performed. CONCLUSIONS RT-PCR is a reliable method for diagnosing severe CAP using sterile materials and a potentially applicable method in patients with clinical, radiological and non-specific laboratory characteristics of lower respiratory tract infection, especially in complicated cases with pleural effusion.
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Affiliation(s)
| | - Daniel Jarovsky
- Pediatric Infectious Disease Unit, Santa Casa de São Paulo, São Paulo 01221-010, Brazil
| | | | | | | | - Eitan Naaman Berezin
- Pediatric Infectious Disease Unit, Santa Casa de São Paulo, São Paulo 01221-010, Brazil
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The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children. J Clin Med 2022; 11:jcm11195506. [PMID: 36233374 PMCID: PMC9571658 DOI: 10.3390/jcm11195506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 11/22/2022] Open
Abstract
Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634−0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67−0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67−0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.
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Ojuawo O, Ojuawo A, Aladesanmi A, Adio M, Iroh Tam PY. Childhood pneumonia diagnostics: a narrative review. Expert Rev Respir Med 2022; 16:775-785. [DOI: 10.1080/17476348.2022.2099842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Olutobi Ojuawo
- Global Health Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ayotade Ojuawo
- General Practice Specialty, St Helens and Knowsley Teaching Hospitals NHS Trust (Lead Employer), United Kingdom
| | | | - Mosunmoluwa Adio
- Acute Medical Unit, North Cumbria Integrated Care NHS Foundation Trust, United Kingdom
| | - Pui-Ying Iroh Tam
- Paediatrics and Child Health Research Group, Malawi – Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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7
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Kelly E, Whelan SO, Harriss E, Murphy S, Pollard AJ, O' Connor D. Systematic review of host genomic biomarkers of invasive bacterial disease: Distinguishing bacterial from non-bacterial causes of acute febrile illness. EBioMedicine 2022; 81:104110. [PMID: 35792524 PMCID: PMC9256842 DOI: 10.1016/j.ebiom.2022.104110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Infectious diseases play a significant role in the global burden of disease. The gold standard for the diagnosis of bacterial infection, bacterial culture, can lead to diagnostic delays and inappropriate antibiotic use. The advent of high- throughput technologies has led to the discovery of host-based genomic biomarkers of infection, capable of differentiating bacterial from other causes of infection, but few have achieved validation for use in a clinical setting. Methods A systematic review was performed. PubMed/Ovid Medline, Ovid Embase and Scopus databases were searched for relevant studies from inception up to 30/03/2022 with forward and backward citation searching of key references. Studies assessing the diagnostic performance of human host genomic biomarkers of bacterial infection were included. Study selection and assessment of quality were conducted by two independent reviewers. A meta-analysis was undertaken using a diagnostic random-effects model. The review was registered with PROSPERO (ID: CRD42021208462). Findings Seventy-two studies evaluating the performance of 116 biomarkers in 16,216 patients were included. Forty-six studies examined TB-specific biomarker performance and twenty-four studies assessed biomarker performance in a paediatric population. The results of pooled sensitivity, specificity, negative and positive likelihood ratio, and diagnostic odds ratio of genomic biomarkers of bacterial infection were 0.80 (95% CI 0.78 to 0.82), 0.86 (95% CI 0.84 to 0.88), 0.18 (95% CI 0.16 to 0.21), 5.5 (95% CI 4.9 to 6.3), 30.1 (95% CI 24 to 37), respectively. Significant between-study heterogeneity (I2 77%) was present. Interpretation Host derived genomic biomarkers show significant potential for clinical use as diagnostic tests of bacterial infection however, further validation and attention to test platform is warranted before clinical implementation can be achieved. Funding No funding received.
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Affiliation(s)
- Eimear Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Seán Olann Whelan
- Department of Clinical Microbiology, Galway University Hospital, Galway, Ireland
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford
| | - Sarah Murphy
- Department of Paediatrics, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Daniel O' Connor
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford. UK; NIHR Oxford Biomedical Research Centre, Oxford, UK
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Ojuawo OB, Iroh Tam PY. Childhood Pneumonia Diagnostics in Sub-Saharan Africa: A Systematic Review. J Trop Pediatr 2022; 68:6604072. [PMID: 35674266 DOI: 10.1093/tropej/fmac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The prompt and accurate aetiological diagnosis of childhood pneumonia remains a challenge, especially in sub-Saharan Africa (SSA) because of limited resources for disease management. OBJECTIVE To review existing diagnostics for childhood pneumonia and potential modalities available to differentiate between bacterial and viral aetiologies in SSA. METHODS Online databases were searched for relevant articles published between January 2010 and December 2020 regarding childhood pneumonia diagnosis, conducted in SSA in children less than 18 years of age. The 2020 PRISMA checklist was utilized in appraising the selected studies and the QUADAS-2 tool was employed to assess the risk of bias in each of the studies selected. RESULTS A total of 1542 study titles and abstracts were screened following which 45 studies (39 on childhood pneumonia diagnostics and 6 on discriminating between bacterial and viral childhood pneumonia) were selected for review. Microbiological investigations (79.7%) constituted the most utilized index tests with blood-related specimen (32.8%) being the most utilized specimen. The most performed index diagnostic modality was polymerase chain reaction (PCR) (53.1%). The commonest reference gold standard technique was based on clinical diagnosis of the disease (46.2%). Only six studies in SSA attempted at using serum biomarkers, either singly or in combination to distinguish between aetiologies with use of combined biomarkers showing promise. CONCLUSION Microbiological investigations are the most employed diagnostic methods for childhood pneumonia in SSA. More studies are required to evaluate the potential use of serum biomarkers; either singly or in combination with the goal of discriminating bacterial and viral childhood pneumonia.
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Affiliation(s)
| | - Pui-Ying Iroh Tam
- Respiratory Department, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham B187QH, UK.,Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Pokhrel B, Koirala T, Gautam D, Kumar A, Camara BS, Saw S, Daha SK, Gurung S, Khulal A, Yadav SK, Baral P, Gurung M, Shrestha S. Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal. Trop Med Infect Dis 2021; 6:55. [PMID: 33923973 PMCID: PMC8167730 DOI: 10.3390/tropicalmed6020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
In the era of growing antimicrobial resistance, there is a concern about the effectiveness of first-line antibiotics such as ampicillin in children hospitalized with community-acquired pneumonia. In this study, we describe antibiotic use and treatment outcomes among under-five children with community-acquired pneumonia admitted to a tertiary care public hospital in Nepal from 2017 to 2019. In this cross-sectional study involving secondary analysis of hospital data, there were 659 patients and 30% of them had a history of prehospital antibiotic use. Irrespective of prehospital antibiotic use, ampicillin monotherapy (70%) was the most common first-line treatment provided during hospitalization followed by ceftriaxone monotherapy (12%). The remaining children (18%) were treated with various other antibiotics alone or in combination as first-line treatment. Broad-spectrum antibiotics such as linezolid, vancomycin, and meropenem were used in less than 1% of patients. Overall, 66 (10%) children were required to switch to second-line treatment and only 7 (1%) children were required to switch to third-line treatment. Almost all (99%) children recovered without any sequelae. This study highlights the effectiveness of ampicillin monotherapy in the treatment of community-acquired pneumonia in hospitalized children in a non-intensive care unit setting.
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Affiliation(s)
- Bhishma Pokhrel
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Tapendra Koirala
- Department of Health Services, Ministry of Health and Population, Kathmandu 44600, Nepal
| | - Dipendra Gautam
- World Health Emergencies Program, WHO Country Office, Kathmandu 44600, Nepal;
| | - Ajay Kumar
- International Union against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi 110016, India;
- International Union against Tuberculosis and Lung Disease, 75006 Paris, France
- Yenepoya Medical College, Yenepoya, Mangaluru 575018, India
| | - Bienvenu Salim Camara
- Central National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah 4090, Guinea;
| | - Saw Saw
- Department of Medical Research, Ministry of Health and Sports, Yangon 05081, Myanmar;
| | - Sunil Kumar Daha
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Sunaina Gurung
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Animesh Khulal
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Sonu Kumar Yadav
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Pinky Baral
- Modern Technical College, Sanepa, Lalitpur 44700, Nepal;
| | - Meeru Gurung
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
| | - Shrijana Shrestha
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; (S.K.D.); (S.G.); (A.K.); (S.K.Y.); (M.G.); (S.S.)
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10
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Akahoshi S, Morikawa Y, Sakakibara H, Kaneko T, Sekine A, Obonai T, Hataya H. Risk factors of bacteremia in children hospitalized with community-acquired pneumonia: A nested case-control study. J Infect Chemother 2021; 27:1198-1204. [PMID: 33814348 DOI: 10.1016/j.jiac.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the risk factors of bacteremia in children hospitalized with community-acquired pneumonia (CAP). STUDY DESIGN The present, nested, case-control study enrolled a cohort of patients with CAP aged < 18 years who were hospitalized at Tokyo Metropolitan Children's Medical Center or Tama-Hokubu Medical Center between March 2010 and February 2018. Among the cohort with blood cultures (BCs), patients with bacteremia were identified and matched with five control patients based on their treatment facility, underlying disease, and age. Conditional logistic regression was used to calculate the odds ratios (ORs) of bacteremia for risk factor candidates. RESULTS BCs were obtained for 2,383 (84%) of the 2,853 patients in the CAP cohort. Of those with BCs, 34 (1.4%) had bacteremia. S. pneumoniae and H. influenzae accounted for 26 (76%) and four (12%) instances of the bacteremia pathogens, respectively. Bacteremia occurred more frequently among patients hospitalized in the spring than during other seasons (P = 0.022). On multivariate analysis, the severity of pneumonia was not associated with bacteremia incidence (OR: 0.92 [0.30-2.85]) while a white blood cell count > 16,000/μL (OR: 5.90 [2.14-16.3]) was shown to be a significant risk factor. The OR of the need for a ventilator on admission day was significantly high (28.4 [3.02-1374]) on univariate analysis, but the subject pool was too small to determine its significance on multivariate analysis. CONCLUSIONS The results of the present study supported BC collection in patients with leukocytosis and in those requiring ventilator use on admission.
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Affiliation(s)
- Shogo Akahoshi
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Asami Sekine
- Department of Pediatrics, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, 1 Chome-7-1 Aobacho, Higashimurayama, Tokyo, 189-8511, Japan
| | - Toshimasa Obonai
- Department of Pediatrics, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, 1 Chome-7-1 Aobacho, Higashimurayama, Tokyo, 189-8511, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
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11
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Haase R, Baier J, Cristofolini M, Scheller K, Moritz S. [Effects of an In-House Antibiotic Stewardship Initiative on Diagnosis and Management of Community-Acquired Pneumonia in Childhood and Adolescence]. Pneumologie 2021; 75:507-515. [PMID: 33556975 DOI: 10.1055/a-1346-4444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pediatric community-acquired pneumonia (pCAP) often leads to prescription of antibiotics and hospital admission of children. Unfortunately, adherence to diagnosis and treatment guidelines is inconsistent, and misuse of antibiotics may occur. Antimicrobial stewardship interventions, which were started in many hospitals during the last decade, can optimize management of pCAP without negative patient outcomes. OBJECTIVES The objective of this retrospective analysis was to assess the influence of a newly implemented in-house pediatric antibiotic stewardship (ABS) initiative on guideline adherence and treatment quality. MATERIALS AND METHODS Retrospective, patients' file-based analysis of the effects of an ABS initiative in a pediatric university hospital from January 2017 until March 2020. ABS initiative included creation of a local pCAP guideline for hospitalized children aged 90 days - 18 years, periodic training and continuous ABS support. RESULTS A total of 230 patients with pCAP were included (145 before and 85 after intervention). Implementation of the ABS program led to reduction of antibiotics prescription without clear indication from 26 % to 10 % (p < 0.05). The inappropriate use of antibiotics decreased from 64 % to 27 % (p < 0.05), the rate of incorrect doses declined from 17 % to 10 % (p < 0.05) and the mean duration of antibiotic treatment declined from 10 to 7 days (p < 0.05). There were no differences between the two groups regarding length of stay, treatment failure or readmissions for respiratory infection. CONCLUSIONS Pediatric antibiotic stewardship is an appropriate and safe method, and is beneficial to hospitalized patients with pCAP. Application of ABS programs may increase adherence to clinical guidelines and improve appropriate antimicrobial use without negative impact on patient outcomes. Multicenter follow-up studies are needed to clarify long-term effects of ABS programs.
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Affiliation(s)
- R Haase
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Halle, Halle.,Klinik für Neonatologie und Kinderintensivmedizin, Krankenhaus St. Elisabeth und St. Barbara, Halle
| | - J Baier
- Abteilung für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Halle, Halle
| | - M Cristofolini
- Landesamt für Verbraucherschutz Sachsen-Anhalt, Magdeburg
| | - K Scheller
- Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Universitätsklinikum Halle, Halle
| | - S Moritz
- Klinische Infektiologie, Universitätsklinikum Halle, Halle
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12
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Battula V, Krupanandan RK, Nambi PS, Ramachandran B. Safety and Feasibility of Antibiotic De-escalation in Critically Ill Children With Sepsis - A Prospective Analytical Study From a Pediatric ICU. Front Pediatr 2021; 9:640857. [PMID: 33763396 PMCID: PMC7982649 DOI: 10.3389/fped.2021.640857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/12/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: De-escalation is the key to balance judicious antibiotic usage for life-threatening infections and reducing the emergence of antibiotic resistance caused by antibiotic overuse. Robust evidence is lacking regarding the safety of antibiotic de-escalation in culture negative sepsis. Materials and Methods: Children admitted to the PICU during the first 6 months of 2019 with suspected infection were included. Based on the clinical condition, cultures and septic markers, antibiotics were de-escalated or continued at 48-72 h. Outcome data like worsening of primary infection, acquisition of hospital acquired infection, level of ICU support and mortality were captured. Results: Among the 360 admissions, 247 (68.6%) children received antibiotics. After excluding 92 children, 155 children with 162 episodes of sepsis were included in the study. Thirty four episodes were not eligible for de-escalation. Among the eligible group of 128 episodes, antibiotics were de-escalated in 95 (74.2%) and continued in 33 (25.8%). The primary infection worsened in 5 (5.2%) children in the de-escalation group and in 1 (3%) in non de-escalation group [Hazard ratio: 2.12 (95%CI: 0.39-11.46)]. There were no significant differences in rates of hospital acquired infection, mortality or length of ICU stay amongst the groups. Blood cultures and assessment of clinical recovery played a major role in de-escalation of antibiotics and the clinician's hesitation to de-escalate in critically ill culture negative children was the main reason for not de-escalating among eligible children. Conclusion: Antibiotic de-escalation appears to be a safe strategy to apply in criticallly ill children, even in those with negative cultures.
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Affiliation(s)
- Vasudha Battula
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | - Ravi Kumar Krupanandan
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | - P Senthur Nambi
- Department of Pediatric Infectious Diseases, Kanchi Kamakoti CHILDS Trust Hospital and The CHILDS Trust Medical Research Foundation, Chennai, India
| | - Bala Ramachandran
- Department of Pediatric Critical Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
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13
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Gareca Perales J, Soleto Ortiz L, Loayza Mafayle R, Machuca Soto B, Hidalgo Flores L, López Montaño J, Zuna Calle N, Jarovsky D, Naaman Berezin E. Diagnosis of Community-acquired Pneumonia in Hospitalized Children: A Multicenter Experience in Bolivia. Pediatr Infect Dis J 2021; 40:32-38. [PMID: 33006878 DOI: 10.1097/inf.0000000000002909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) represents a major cause of hospitalization, especially among young children. In the third world countries, information about CAP etiology is scarce. Therefore, rapid and highly sensitive diagnostic methods are crucial to determine etiologic agents. METHODS Between March 2016 and March 2017, we have prospectively studied the clinical, radiologic, laboratory, and molecular aspects of patients with CAP at 2 tertiary-level hospitals in Santa Cruz de la Sierra, using a multiplex real-time polymerase chain reaction (RT-PCR). RESULTS A total of 274 children were evaluated, with a median age of 13 months. An etiologic agent was identified in 187 patients (68.2%): 54% (n = 148) were viruses and 14.2% (n = 39) were bacteria. CAP prevalence was highest among children under 2 years (71%; 195/274); respiratory syncytial virus (RSV) was the most frequent cause in 22% (60/274), especially among infants, followed by influenza (14.5%; 40/274). Streptococcus pneumoniae accounted for 7% of the total (19/274), followed by Staphylococcus aureus (3%;8/274) and Haemophilus influenzae (1.4%;4/274). Together, these cases accounted for 79.5% (31/39) of all bacterial CAP. Pleural effusion (PE) complicated CAP in 13.8% (38/274), of which 29 were of bacterial etiology. RT-PCR increased the detection rate of pneumococcus by 47%. Coinfection occurred in 28 patients (10%); 26 (9.5%) required intensive care and 9 patients (3%) died. CONCLUSIONS RT-PCR provided additional diagnostic value to conventional, clinical, and laboratory methods. The higher prevalence of RSV, influenza, and Streptococcus pneumoniae reveals the need for preventive measures with better vaccine uptake and future research for RSV vaccines.
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Affiliation(s)
- José Gareca Perales
- From the Centro de Pediatría Especializada "CRECER," Santa Cruz de la Sierra, Bolivia
| | - Lorena Soleto Ortiz
- Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz de la Sierra, Bolivia
| | - Roxana Loayza Mafayle
- Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz de la Sierra, Bolivia
| | - Blanca Machuca Soto
- Hospital Municipal de Niños "Dr. Mario Ortiz Suárez," Santa Cruz de la Sierra, Bolivia
| | - Lucia Hidalgo Flores
- Hospital Municipal de Niños "Dr. Mario Ortiz Suárez," Santa Cruz de la Sierra, Bolivia
| | - Javier López Montaño
- Hospital Municipal de Niños "Dr. Mario Ortiz Suárez," Santa Cruz de la Sierra, Bolivia
| | | | - Daniel Jarovsky
- Pediatric Infectious Disease Unit, Santa Casa de São Paulo, São Paulo, Brazil
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14
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Dudognon D, Levy C, Chalumeau M, Biscardi S, Dommergues MA, Dubos F, Levieux K, Aurel M, Minodier P, Zenkhri F, Mezgueldi E, Craiu I, Morin L, Béchet S, Varon E, Cohen R, Cohen JF. Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009-2018. Front Pediatr 2021; 9:684628. [PMID: 34746044 PMCID: PMC8567958 DOI: 10.3389/fped.2021.684628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP. Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009-2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves. Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64-0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43-0.60]) and of ANC (0.55 [0.46-0.64]), but not than that of CRP (0.66 [0.56-0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively. Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP.
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Affiliation(s)
- Danaé Dudognon
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Martin Chalumeau
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Epidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
| | - Sandra Biscardi
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Marie-Aliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of General Pediatrics, Centre Hospitalier de Versailles-Le Chesnay, Versailles, France
| | - François Dubos
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Univ. Lille, CHU Lille, Lille, France
| | - Karine Levieux
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Aurel
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of General Pediatrics, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Philippe Minodier
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Centre Hospitalier Universitaire Nord, Marseille, France
| | - Ferielle Zenkhri
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, France
| | - Ellia Mezgueldi
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, France
| | - Irina Craiu
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, France
| | - Laurence Morin
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Service des Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jérémie F Cohen
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Epidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
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15
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Yadav RK, Kumar D, Singh A, Ziauddin M, Singh DK. Clinical and microbial spectrum of community-acquired pneumonia in children of north India. Trop Doct 2020; 51:71-77. [PMID: 33236693 DOI: 10.1177/0049475520971595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We compared the clinical, radiological and microbial profile in children suffering from community-acquired pneumonia in rural populations of north India. A total of 125 such children were divided into two age groups of 2-12 months (Group A) and 13-60 months (Group B). After taking a history and clinical examination, routine investigations including full blood count, blood, urine, and nasopharyngeal swab culture and radiology were performed. Multiplex polymerase chain reaction for Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae and Haemophilus influenzae was carried out. Failure to eat or drink was more common (40.9%) in Group A, than Group B (18.7%). Lung consolidation was more common in Group B. Blood and urine culture were found to be more positive in Group A while combined nasopharyngeal culture and multiplex polymerase chain reaction favoured more bacterial growth in Group B.
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Affiliation(s)
- Rajesh Kumar Yadav
- Professor and Head, Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Dinesh Kumar
- Associate Professor, Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Amit Singh
- Professor, Department of Microbiology, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Mohd Ziauddin
- Assistant Professor, Department of Pediatrics, Hind Institute of Medical Science, Sitapur, India
| | - Dinesh Kumar Singh
- Professor, Department of Pediatrics, FH Medical College and Hospital, Firozabad, India
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16
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Wacharachaisurapol N, Jitrungruengnij N, Janewongwirot P, Suchartlikitwong P, Chautrakarn S, Jantarabenjakul W, Anugulruengkitt S, Theerawit T, Sophonphan J, Deerojanawong J, Pancharoen C, Puthanakit T. High prescribing rates of third-generation cephalosporins in children hospitalized with acute lower respiratory infections at a university hospital. Int J Infect Dis 2020; 102:369-374. [PMID: 33186703 DOI: 10.1016/j.ijid.2020.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Antibiotics are frequently prescribed for the treatment of acute lower respiratory infections (ALRI) in children ≤5 years of age, even though viral aetiologies are the most common. The aim of this study was to describe antibiotic prescribing rates and patterns in children ≤5 years of age hospitalized with ALRI. METHODS A retrospective study was conducted involving patients aged 1 month to 5 years hospitalized with ALRI at a university hospital. Patient demographics, ALRI diagnosis, microbiological data, antibiotics prescribed, and treatment outcomes were recorded and analysed. RESULTS A total of 1283 patients were enrolled. Their median age was 1.6 years (interquartile range 0.8-2.8 years). Thirty-six percent had a co-morbidity. The diagnosis at discharge was viral ALRI in 81% and bacterial pneumonia in 19%. The mortality rate was 0.4%. The overall antibiotic prescribing rate was 46% (95% confidence interval 43-49%). Antibiotic prescribing rates were higher among children with co-morbidities (65% vs 35%, p < 0.001) and older children (57% for >2-5 years vs 39% for ≤2 years, p < 0.001). Parenteral third-generation cephalosporins were prescribed in up to 68% of all prescriptions. CONCLUSIONS Nearly-half of hospitalized children with ALRI were prescribed antibiotics. The majority of prescribed antibiotics were third-generation cephalosporins. An antimicrobial stewardship programme and antibiotic guidelines should be implemented to promote the judicious use of antibiotics.
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Affiliation(s)
- Noppadol Wacharachaisurapol
- Clinical Pharmacokinetics and Pharmacogenomics Research Unit, Department of Pharmacology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Nattapong Jitrungruengnij
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pakpoom Janewongwirot
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pintip Suchartlikitwong
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sineenart Chautrakarn
- Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Watsamon Jantarabenjakul
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Thai Red Cross Emerging Infectious Diseases Clinical Centre, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Suvaporn Anugulruengkitt
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tuangtip Theerawit
- Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jiratchaya Sophonphan
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Jitladda Deerojanawong
- Division of Paediatric Pulmonary, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chitsanu Pancharoen
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Centre of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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17
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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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18
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Wang W, Zhu Y, Yin L, Deng Y, Chu G, Liu S. Utilization of serum procalcitonin as a biomarker in the diagnosis and treatment of children with bacterial hospital-acquired pneumonia. Mol Cell Biochem 2020; 476:261-267. [PMID: 32990893 PMCID: PMC7522182 DOI: 10.1007/s11010-020-03902-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023]
Abstract
Hospital-acquired pneumonia (HAP) is one of the common infections in hospitalized patients. Early and prompt diagnosis of HAP is important because it aids in the appropriate selection of antibiotics and decreases the mortality and morbidity of patients. The investigation on serum procalcitonin (PCT) levels in pediatric patients is limited. Herein we aimed to evaluate the role of PCT in the early diagnosis of children with bacterial HAP. The study enrolled 264 children (< 14 years old) who were radiographically detected by pulmonary condensation chest X-rays. The HAP patients were stratified by patterns of microbiological detection of pathogens. Baseline white blood cell (WBC) count, neutrophil proportion, PCT, and C-reactive protein (CRP) were measured on admission. The laboratory findings and microbiological findings were analyzed and compared among groups. The median PCT concentration of patients with typical bacterial pathogens (3.95 ± 3.75 ng/mL) was significantly higher than the one of the patients with other pathogen types (median lower than 1.20 ng/mL). Correlation analysis indicated a significant correlation between PCT concentrations and the main inflammation makers including WBC count, neutrophil proportion, and CRP. PCT level was significantly decreased to 0.86 ± 1.46 ng/mL in post-treatment patients (p < 0.001). This cohort study with 264 pediatric HAP patients demonstrated the reliability of PCT level as a biomarker in patients with typical bacterial pathogens. Specifically, PCT cutoffs of 2 ng/mL accurately identified HAP children with typical bacterial pathogens. This finding suggested that PCT may serve as a reliable biomarker for the early diagnosis and treatment indicator of children with HAP.
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Affiliation(s)
- Wenlong Wang
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China.
| | - Yitang Zhu
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Linlin Yin
- Department of Clinical Laboratory, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
| | - Yaoyao Deng
- Clinical Laboratory, Mengcun Hui Autonomous County Hospital, Chaoyang Dajie, Mengcun Hui Autonomous County, Cangzhou, 061400, Hebei, China
| | - Guoxian Chu
- Clinical Laboratory, People's Hospital of Qingxian, Nanhuanxi Road, Qingxian, Cangzhou, 062650, Hebei, China
| | - Supin Liu
- Department of Blood Collection Center, Cangzhou Central Hospital, No.16 Xinhua West Road, Cangzhou, 061001, Hebei, China
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19
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Duan N, Du J, Huang C, Li H. Microbial Distribution and Antibiotic Susceptibility of Lower Respiratory Tract Infections Patients From Pediatric Ward, Adult Respiratory Ward, and Respiratory Intensive Care Unit. Front Microbiol 2020; 11:1480. [PMID: 32695092 PMCID: PMC7338583 DOI: 10.3389/fmicb.2020.01480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Lower respiratory tract infections (LRTIs) account for significant morbidity and mortality in patients admitted to hospitals worldwide, especially in children and elderly. The prevalent microorganisms and antibiotic susceptibility were investigated among LRTI patients from the pediatric ward, adult respiratory ward, and respiratory intensive care unit (RICU) in order to achieve more efficient treatment protocols and better recovery. Methods In this retrospective cross-sectional study (January 2016 to December 2019), 4,161 positive culture samples out of 18,798 different specimens (9,645 respiratory tract samples and 9,153 blood samples) from LRTI patients were analyzed for pathogen incidence and antibiotic sensitivity. Results Among the respiratory tract cultures, the frequency of Gram-negative bacterial strains was higher than Gram-positive bacterial strains. Pseudomonas aeruginosa was the dominant pathogen in both the adult respiratory ward (n = 156, 21.49%) and RICU (n = 975, 35.67%), whereas Staphylococcus aureus (n = 66, 19.19%) was the most common bacterium in the pediatric ward. Among the blood cultures, Gram-positive bacteria remained the major microorganisms involved in LRTIs, and the most frequent pathogen was Staphylococcus epidermidis (n = 59, 47.20%) in the pediatric ward and Staphylococcus aureus (n = 10, 21.8%) in adult respiratory ward. However, Gram-negative bacteria were the main pathogens in the RICU, of which Klebsiella pneumoniae (n = 51, 27.57%) is the most prevalent. Pseudomonas aeruginosa of LRTI patients remained highly susceptible (>70%) to routine antibiotics in pediatric ward. However, it only had high susceptibility to amikacin, tobramycin, gentamicin in both the adult respiratory ward and RICU and its antibiotic sensitivity to meropenem and imipenem was moderate in the adult respiratory ward and mild (<30%) in the RICU. Staphylococcus aureus isolated from LRTI patients was highly susceptible to linezolid, daptomycin, teicoplanin, vancomycin, tigecycline, rifampicin, and trimethoprim/sulfamethoxazole in all three wards, moderately susceptible to gentamicin in both the adult respiratory ward and RICU and to clindamycin, oxacillin, moxifloxacin only in the adult respiratory ward. Conclusions Microbial distribution and their patterns of antibiotic susceptibility revealed a high divergence among LRTI patients admitted to different wards in this hospital. Thus, different antibiotic therapies should be considered for distinct age groups.
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Affiliation(s)
- Nan Duan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Jialin Du
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Chenwei Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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20
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Youssef AS, Fanous M, Siddiqui FJ, Estrada J, Chorny V, Braiman M, Mayer EF. Value of Blood Cultures in the Management of Children Hospitalized with Community-Acquired Pneumonia. Cureus 2020; 12:e8222. [PMID: 32582483 PMCID: PMC7306671 DOI: 10.7759/cureus.8222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and objectives Current guidelines for the management of community-acquired pneumonia (CAP) in children recommend obtaining a blood culture for children with moderate to severe pneumonia; yet, there is no guidance to assess the severity of the disease. Thus, a blood culture is obtained for the majority of children admitted with CAP, regardless of the severity of their symptoms. The study was designed to investigate and identify the prevalence of bacteremia in pediatric patients hospitalized with CAP and to evaluate the clinical and laboratory variables associated with bacteremia. Methods We conducted a medical record review of children aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers. We used binary logistic regression analysis and chi-square tests to look at factors associated with blood culture positivity. Results A total of 464 patients were admitted with CAP. Blood cultures were obtained in 357 (76.9%) patients; 23 patients had repeated cultures. Fifteen patients had positive cultures: 5/380 (1.3%) were considered true positive results and 10/380 (2.6%) were considered contaminants. Intensive care unit (ICU) admission (OR 5.6 with 95% CI (1- 31), p<0.03), toxic appearance (OR 12.8 with 95% CI (1.3-125), p<0.01), and significantly elevated C-reactive protein (CRP) (>300 mg/L (p<0.01) were associated with bacteremia. Conclusion The prevalence of bacteremia among children admitted for CAP is low. The use of routine blood cultures should be reserved for children with moderate to severe pneumonia. Further studies are required to better risk-stratify children with CAP.
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Affiliation(s)
- Ahmed S Youssef
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Mina Fanous
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Faisal J Siddiqui
- Neonatology, State University of New York Downstate Medical Center, New York, USA
| | | | - Valeriy Chorny
- Pediatrics, New York University School of Medicine, New York, USA
| | - Melvyn Braiman
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
| | - Erick F Mayer
- Pediatrics, State University of New York Downstate Medical Center, New York, USA
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21
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Iqbal H, Rhee DK. Ginseng alleviates microbial infections of the respiratory tract: a review. J Ginseng Res 2020; 44:194-204. [PMID: 32148400 PMCID: PMC7031735 DOI: 10.1016/j.jgr.2019.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 12/26/2022] Open
Abstract
The detrimental impact of air pollution as a result of frequent exposure to fine particles posed a global public health risk mainly to the pulmonary disorders in pediatric and geriatric population. Here, we reviewed the current literature regarding the role of ginseng and/or its components as antimicrobials, especially against pathogens that cause respiratory infections in animal and in vitro models. Some of the possible mechanisms for ginseng-mediated viral inhibition suggested are improvements in systemic and mucosa-specific antibody responses, serum hemagglutinin inhibition, lymphocyte proliferation, cell survival rate, and viral clearance in the lungs. In addition, ginseng reduces the expression levels of proinflammatory cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-5, IL-6, IL-8) and chemokines produced by airway epithelial cells and macrophages, thus preventing weight loss. In case of bacterial infections, ginseng acts by alleviating inflammatory cytokine production, increasing survival rates, and activating phagocytes and natural killer cells. In addition, ginseng inhibits biofilm formation and induces the dispersion and dissolution of mature biofilms. Most clinical trials revealed that ginseng, at various dosages, is a safe and effective method of seasonal prophylaxis, relieving the symptoms and reducing the risk and duration of colds and flu. Taken together, these findings support the efficacy of ginseng as a therapeutic and prophylactic agent for respiratory infections.
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Key Words
- ARI, acute respiratory illness
- Bacteria
- COPD, chronic obstructive pulmonary disease
- Clinical trials
- GSLS, ginseng stem–leaf saponins
- Ginseng
- HRV, human rhinovirus
- IFN, interferon
- IL, interleukin
- IgA, immunoglobulin A
- PD, protopanaxadiol
- PT, protopanaxatriol
- ROS, reactive oxygen species
- RSV, respiratory syncytial virus
- RTIs, respiratory tract infections
- Respiratory tract infections
- TNF-α, tumor necrosis factor-alpha
- Virus
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Affiliation(s)
| | - Dong-kwon Rhee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
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22
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Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev 2019; 32:3-9. [PMID: 31422032 PMCID: PMC6990397 DOI: 10.1016/j.prrv.2019.06.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review epidemiology, aetiology and management of childhood pneumonia in low-and-middle-income countries. DESIGN Review of published English literature between 2013 and 2019. RESULTS Pneumonia remains a major cause of morbidity and mortality. Risk factors include young age, malnutrition, immunosuppression, tobacco smoke or air pollution exposure. Better methods for specimen collection and molecular diagnostics have improved microbiological diagnosis, indicating that pneumonia results from several organisms interacting. Induced sputum increases microbiologic yield for Bordetella pertussis or Mycobacterium tuberculosis, which has been associated with pneumonia in high TB prevalence areas. The proportion of cases due to Streptococcus pneumoniae and Haemophilus influenzae b has declined with new conjugate vaccines; Staphylococcus aureus and H. influenzae non-type b are the commonest bacterial pathogens; viruses are the most common pathogens. Effective interventions comprise antibiotics, oxygen and non-invasive ventilation. New vaccines have reduced severity and incidence of disease, but disparities exist in uptake. CONCLUSION Morbidity and mortality from childhood pneumonia has decreased but a considerable preventable burden remains. Widespread implementation of available, effective interventions and development of novel strategies are needed.
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MESH Headings
- Age Factors
- Air Pollution/statistics & numerical data
- Anti-Bacterial Agents/therapeutic use
- Child Nutrition Disorders/epidemiology
- Child, Preschool
- Developing Countries
- Haemophilus Infections/epidemiology
- Haemophilus Infections/microbiology
- Haemophilus Infections/prevention & control
- Haemophilus Infections/therapy
- Humans
- Infant
- Infant, Newborn
- Noninvasive Ventilation/methods
- Oxygen Inhalation Therapy/methods
- Pneumonia/epidemiology
- Pneumonia/microbiology
- Pneumonia/prevention & control
- Pneumonia/therapy
- Pneumonia, Pneumococcal/epidemiology
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/prevention & control
- Pneumonia, Pneumococcal/therapy
- Pneumonia, Staphylococcal/epidemiology
- Pneumonia, Staphylococcal/microbiology
- Pneumonia, Staphylococcal/therapy
- Risk Factors
- Tobacco Smoke Pollution/statistics & numerical data
- Tuberculosis, Pulmonary/epidemiology
- Tuberculosis, Pulmonary/microbiology
- Tuberculosis, Pulmonary/prevention & control
- Tuberculosis, Pulmonary/therapy
- Vaccines/therapeutic use
- Whooping Cough/epidemiology
- Whooping Cough/microbiology
- Whooping Cough/prevention & control
- Whooping Cough/therapy
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Department of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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23
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Gómez-Carballa A, Cebey-López M, Pardo-Seco J, Barral-Arca R, Rivero-Calle I, Pischedda S, Currás-Tuala MJ, Gómez-Rial J, Barros F, Martinón-Torres F, Salas A. A qPCR expression assay of IFI44L gene differentiates viral from bacterial infections in febrile children. Sci Rep 2019; 9:11780. [PMID: 31409879 PMCID: PMC6692396 DOI: 10.1038/s41598-019-48162-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of bacterial infections in hospital settings is currently performed using bacterial culture from sterile site, but they are lengthy and limited. Transcriptomic biomarkers are becoming promising tools for diagnosis with potential applicability in clinical settings. We evaluated a RT-qPCR assay for a 2-transcript host expression signature (FAM89A and IFI44L genes) inferred from microarray data that allow to differentiate between viral and bacterial infection in febrile children. This assay was able to discriminate viral from bacterial infections (P-value = 1.04 × 10-4; AUC = 92.2%; sensitivity = 90.9%; specificity = 85.7%) and showed very high reproducibility regardless of the reference gene(s) used to normalize the data. Unexpectedly, the monogenic IFI44L expression signature yielded better results than those obtained from the 2-transcript test (P-value = 3.59 × 10-5; AUC = 94.1%; sensitivity = 90.9%; specificity = 92.8%). We validated this IFI44L signature in previously published microarray and whole-transcriptome data from patients affected by different types of viral and bacterial infections, confirming that this gene alone differentiates between both groups, thus saving time, effort, and costs. Herein, we demonstrate that host expression microarray data can be successfully translated into a fast, highly accurate and relatively inexpensive in vitro assay that could be implemented in the clinical routine.
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Affiliation(s)
- Alberto Gómez-Carballa
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain.
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain.
| | - Miriam Cebey-López
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jacobo Pardo-Seco
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
| | - Ruth Barral-Arca
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sara Pischedda
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Currás-Tuala
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - José Gómez-Rial
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Barros
- Unidad de Medicina Molecular, Fundación Pública Galega de Medicina Xenómica, CIBERER, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Salas
- Genetics, Vaccines and Infections Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
- Unidade de Xenética, Instituto de Ciencias Forenses, Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, Instituto de Investigaciones Sanitarias (IDIS), Hospital Clínico Universitario de Santiago (SERGAS), Galicia, Spain
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24
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Fritz CQ, Edwards KM, Self WH, Grijalva CG, Zhu Y, Arnold SR, McCullers JA, Ampofo K, Pavia AT, Wunderink RG, Anderson EJ, Bramley AM, Jain S, Williams DJ. Prevalence, Risk Factors, and Outcomes of Bacteremic Pneumonia in Children. Pediatrics 2019; 144:peds.2018-3090. [PMID: 31217309 PMCID: PMC6615516 DOI: 10.1542/peds.2018-3090] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies examining bacteremia in hospitalized children with pneumonia are limited by incomplete culture data. We sought to determine characteristics of children with bacteremic pneumonia using data from a large prospective study with systematic blood culturing. METHODS Children <18 years hospitalized with pneumonia and enrolled in the multicenter Etiology of Pneumonia in the Community study between January 2010 and June 2012 were eligible. Bivariate comparisons were used to identify factors associated with bacteremia. Associations between bacteremia and clinical outcomes were assessed by using Cox proportional hazards regression for length of stay and logistic regression for ICU admission and invasive mechanical ventilation or shock. RESULTS Blood cultures were obtained in 2143 (91%) of 2358 children; 46 (2.2%) had bacteremia. The most common pathogens were Streptococcus pneumoniae (n = 23, 50%), Staphylococcus aureus (n = 6, 13%), and Streptococcus pyogenes (n = 4, 9%). Characteristics associated with bacteremia included male sex, parapneumonic effusion, lack of chest indrawing or wheezing, and no previous receipt of antibiotics. Children with bacteremia had longer lengths of stay (median: 5.8 vs 2.8 days; adjusted hazard ratio: 0.79 [0.73-0.86]) and increased odds of ICU admission (43% vs 21%; adjusted odds ratio: 5.21 [3.82-6.84]) and invasive mechanical ventilation or shock (30% vs 8%; adjusted odds ratio: 5.28 [2.41-11.57]). CONCLUSIONS Bacteremia was uncommonly detected in this large multicenter cohort of children hospitalized with community-acquired pneumonia but was associated with severe disease. S pneumoniae was detected most often. Blood culture was of low yield in general but may have greater use in those with parapneumonic effusion and ICU admission.
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Affiliation(s)
- Cristin Q. Fritz
- Monroe Carell Jr. Children’s Hospital at
Vanderbilt, Nashville, Tennessee
| | - Kathryn M. Edwards
- Monroe Carell Jr. Children’s Hospital at
Vanderbilt, Nashville, Tennessee;,School of Medicine, Vanderbilt University, Nashville,
Tennessee;,Vanderbilt Vaccine Research Program, Nashville,
Tennessee
| | - Wesley H. Self
- School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | - Yuwei Zhu
- School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | - Sandra R. Arnold
- Le Bonheur Children’s Hospital, Memphis,
Tennessee;,University of Tennessee Health Science Center,
Memphis, Tennessee
| | - Jonathan A. McCullers
- Le Bonheur Children’s Hospital, Memphis,
Tennessee;,University of Tennessee Health Science Center,
Memphis, Tennessee;,St. Jude Children’s Research Hospital,
Memphis, Tennessee
| | - Krow Ampofo
- University of Utah Health Sciences Center, Salt Lake
City, Utah
| | - Andrew T. Pavia
- University of Utah Health Sciences Center, Salt Lake
City, Utah
| | | | | | - Anna M. Bramley
- Centers for Disease Control and Prevention, Atlanta,
Georgia
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta,
Georgia
| | - Derek J. Williams
- Monroe Carell Jr. Children’s Hospital at
Vanderbilt, Nashville, Tennessee;,School of Medicine, Vanderbilt University, Nashville,
Tennessee;,Vanderbilt Vaccine Research Program, Nashville,
Tennessee
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25
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Frush JM, Zhu Y, Edwards KM, Grijalva CG, Thomsen IP, Self WH, Jain S, Anderson EJ, Ampofo K, Pavia AT, Arnold SR, McCullers JA, Williams DJ. Prevalence of Staphylococcus aureus and Use of Antistaphylococcal Therapy in Children Hospitalized with Pneumonia. J Hosp Med 2018; 13:848-852. [PMID: 30379141 PMCID: PMC6321763 DOI: 10.12788/jhm.3093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Within a cohort of >2,000 children hospitalized with community-acquired pneumonia, staphylococcal pneumonia was rare (1%) but associated with adverse in-hospital outcomes. Despite this low prevalence, use of antistaphylococcal antibiotics was common (24%). Efforts are needed to minimize overuse of antistaphylococcal antibiotics while also ensuring adequate treatment for pathogen-specific diseases.
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Affiliation(s)
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kathryn M Edwards
- Division of Infectious Diseases, Monroe Carell Jr. Children's Hospital and the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Isaac P Thomsen
- Division of Infectious Diseases, Monroe Carell Jr. Children's Hospital and the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Seema Jain
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Evan J Anderson
- Division of Infectious Diseases, Departments of Medicine and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Krow Ampofo
- Division of Infectious Diseases, Primary Children's Medical Center and the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Andrew T Pavia
- Division of Infectious Diseases, Primary Children's Medical Center and the Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sandra R Arnold
- Division of Infectious Diseases, LeBonheur Children's Hospital and the Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jonathan A McCullers
- Division of Infectious Diseases, LeBonheur Children's Hospital and the Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Derek J Williams
- Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital and the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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26
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Dean P, Florin TA. Factors Associated With Pneumonia Severity in Children: A Systematic Review. J Pediatric Infect Dis Soc 2018; 7:323-334. [PMID: 29850828 PMCID: PMC6454831 DOI: 10.1093/jpids/piy046] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/02/2018] [Indexed: 12/25/2022]
Abstract
Community-acquired pneumonia in children is associated with significant morbidity and mortality; however, data are limited in predicting which children will have negative outcomes, including clinical deterioration, severe disease, or development of complications. The Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pediatric pneumonia guideline includes criteria that were modified from adult criteria and define pneumonia severity to assist with resource allocation and site-of-care decision-making. However, the PIDS/IDSA criteria have not been formally developed or validated in children. Definitions for mild, moderate, and severe pneumonia also vary across the literature, further complicating the development of standardized severity criteria. This systematic review summarizes (1) the current state of the evidence for defining and predicting pneumonia severity in children as well as (2) emerging evidence focused on risk stratification of children with pneumonia.
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Affiliation(s)
- Preston Dean
- Cincinnati Children’s Hospital Medical Center Residency Training Program, Cincinnati Children’s Hospital Medical Center, Ohio,Corresponding Author: Preston Dean, MD, 3333 Burnet Ave, MLC 5018, Cincinnati, OH 45229. E-mail:
| | - Todd A Florin
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical, Ohio,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
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Antillon M, Saad NJ, Baker S, Pollard AJ, Pitzer VE. The Relationship Between Blood Sample Volume and Diagnostic Sensitivity of Blood Culture for Typhoid and Paratyphoid Fever: A Systematic Review and Meta-Analysis. J Infect Dis 2018; 218:S255-S267. [PMID: 30307563 PMCID: PMC6226661 DOI: 10.1093/infdis/jiy471] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Blood culture is the standard diagnostic method for typhoid and paratyphoid (enteric) fever in surveillance studies and clinical trials, but sensitivity is widely acknowledged to be suboptimal. We conducted a systematic review and meta-analysis to examine sources of heterogeneity across studies and quantified the effect of blood volume. Methods We searched the literature to identify all studies that performed blood culture alongside bone marrow culture (a gold standard) to detect cases of enteric fever. We performed a meta-regression analysis to quantify the relationship between blood sample volume and diagnostic sensitivity. Furthermore, we evaluated the impact of patient age, antimicrobial use, and symptom duration on sensitivity. Results We estimated blood culture diagnostic sensitivity was 0.59 (95% confidence interval [CI], 0.54-0.64) with significant between-study heterogeneity (I2, 76% [95% CI, 68%-82%]; P < .01). Sensitivity ranged from 0.51 (95% CI, 0.44-0.57) for a 2-mL blood specimen to 0.65 (95% CI, 0.58-0.70) for a 10-mL blood specimen, indicative of a relationship between specimen volume and sensitivity. Subgroup analysis showed significant heterogeneity by patient age and a weak trend towards higher sensitivity among more recent studies. Sensitivity was 34% lower (95% CI, 4%-54%) among patients with prior antimicrobial use and 31% lower after the first week of symptoms (95% CI, 19%-41%). There was no evidence of confounding by patient age, antimicrobial use, symptom duration, or study date on the relationship between specimen volume and sensitivity. Conclusions The relationship between the blood sample volume and culture sensitivity should be accounted for in incidence and next-generation diagnostic studies.
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Affiliation(s)
- Marina Antillon
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
- Center for Health Economics Research and Modeling of Infectious Diseases, University of Antwerp, Belgium
| | - Neil J Saad
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Stephen Baker
- Oxford University Clinical Research Unit Vietnam, Ho Chi Minh City, Vietnam
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford , Oxford, United Kingdom
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Dierig A, Berger C, Agyeman PKA, Bernhard-Stirnemann S, Giannoni E, Stocker M, Posfay-Barbe KM, Niederer-Loher A, Kahlert CR, Donas A, Hasters P, Relly C, Riedel T, Aebi C, Schlapbach LJ, Heininger U. Time-to-Positivity of Blood Cultures in Children With Sepsis. Front Pediatr 2018; 6:222. [PMID: 30135859 PMCID: PMC6092514 DOI: 10.3389/fped.2018.00222] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Blood cultures are essential for the diagnosis and further appropriate treatment in children with suspected sepsis. In most hospitals, children will be empirically treated or closely monitored for at least 48 h awaiting results of blood cultures. Several studies have challenged the optimal duration of empiric treatment in the era of continuously monitored blood culture systems. The aim of our study was to investigate time-to-positivity (TTP) of blood cultures in children with proven sepsis. Methods: The Swiss Pediatric Sepsis Study prospectively enrolled children 0-16 years of age with blood culture positive sepsis between September 2011 and October 2015. TTP was prospectively assessed in six participating academic pediatric hospitals by fully automated blood culture systems. Results: In 521 (93%) of 562 bacteremia episodes (493 children, median age 103 days, range 0 days-16.9 years) a valid TTP was available. Median TTP was 12 h (IQR 8-17 h, range 0-109 h). By 24, 36, and 48 h, 460 (88%), 498 (96%), and 510 (98%) blood cultures, respectively, were positive. TTP was independent of age, sex, presence of comorbidities, site of infection and severity of infection. Median TTP in all age groups combined was shortest for group B streptococcus (8.7 h) and longest for coagulase-negative staphylococci (16.2 h). Conclusion: Growth of bacteria in blood cultures is detectable within 24 h in 9 of 10 children with blood culture-proven sepsis. Therefore, a strict rule to observe or treat all children with suspected sepsis for at least 48 h is not justified.
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Affiliation(s)
- Alexa Dierig
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Eric Giannoni
- Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
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A 2-transcript host cell signature distinguishes viral from bacterial diarrhea and it is influenced by the severity of symptoms. Sci Rep 2018; 8:8043. [PMID: 29795312 PMCID: PMC5966427 DOI: 10.1038/s41598-018-26239-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/08/2018] [Indexed: 02/03/2023] Open
Abstract
Recently, a biomarker signature consisting of 2-transcript host RNAs was proposed for discriminating bacterial from viral infections in febrile children. We evaluated the performance of this signature in a different disease scenario, namely a cohort of Mexican children (n = 174) suffering from acute diarrhea of different infectious etiologies. We first examined the admixed background of the patients, indicating that most of them have a predominantly Native American genetic ancestry with a variable amount of European background (ranging from 0% to 57%). The results confirm that the RNA test can discriminate between viral and bacterial causes of infection (t-test; P-value = 6.94×10−11; AUC = 80%; sensitivity: 68% [95% CI: 55%–79%]; specificity: 84% [95% CI: 78%–90%]), but the strength of the signal differs substantially depending on the causal pathogen, with the stronger signal being that of Shigella (P-value = 3.14 × 10−12; AUC = 89; sensitivity: 70% [95% CI: 57%–83%]; specificity: 100% [95% CI: 100%–100%]). The accuracy of this test improves significantly when excluding mild cases (P-value = 2.13 × 10−6; AUC = 85%; sensitivity: 79% [95% CI: 58%–95%]; specificity: 78% [95% CI: 65%–88%]). The results broaden the scope of previous studies by incorporating different pathogens, variable levels of disease severity, and different ancestral background of patients, and add confirmatory support to the clinical utility of these 2-transcript biomarkers.
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McDaniel CE, Haaland W, Parlaman J, Zhou C, Desai AD. A Multisite Intervention for Pediatric Community-acquired Pneumonia in Community Settings. Acad Emerg Med 2018; 25:870-879. [PMID: 29513362 DOI: 10.1111/acem.13405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/01/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The majority of children with community-acquired pneumonia (CAP) are primarily evaluated in community hospital emergency departments (EDs); however, studies on the management of pediatric CAP have largely targeted care provided in freestanding children's hospital EDs or inpatient settings. The objectives of this study were to examine whether implementation of a CAP pathway within three community hospital EDs and inpatient units improved process measures related to appropriate laboratory testing and antibiotic prescribing and to compare performance on these measures between the community hospitals and a freestanding children's hospital. METHODS Through a multidisciplinary approach (including general emergency medicine [EM] providers, pediatric fellowship-trained EM providers, and pediatric hospitalists), a CAP pathway was designed and implemented at three community hospitals in January and February 2016. Diagnostic and therapeutic process measures were collected using administrative data and medical record abstraction 1 year pre- and postintervention. Chi-square statistics and statistical process control P-charts were used to examine adherence to these process measures. RESULTS Across the community hospitals, 544 patients preintervention and 321 patients postintervention met inclusion criteria, with 290 children's hospital patients meeting criteria in the postintervention period. Adherence to process measures increased postintervention for appropriate laboratory testing, narrow-spectrum antibiotic stewardship and macrolide stewardship by 10.8% (95% confidence interval [CI] = 4.7% to 16.9%), 8.3% (95% CI = 21.5% to 15.2%), and 3.1% (95% CI = -4.3% to 10.4%), respectively. Statistical process control P-charts demonstrated special cause variation immediately after implementation of the intervention in regards to appropriate laboratory testing. CONCLUSION Implementation of a CAP pathway through a multisite community hospital intervention improved adherence to evidence-based recommendations for laboratory testing and antibiotic stewardship. Similar interventions may improve the quality of care for children with CAP on a population level, as community hospitals are where these patients are seen most frequently.
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Affiliation(s)
| | - Wren Haaland
- Seattle Children's Research Institute Seattle WA
| | - Joshua Parlaman
- Department of Pediatrics University of Washington Seattle WA
| | - Chuan Zhou
- Seattle Children's Research Institute Seattle WA
| | - Arti D. Desai
- Department of Pediatrics University of Washington Seattle WA
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32
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Rodrigues CMC, Groves H. Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis. J Clin Microbiol 2018; 56:e01318-17. [PMID: 29237789 PMCID: PMC5824044 DOI: 10.1128/jcm.01318-17] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Community-acquired pneumonia (CAP) is the leading cause of mortality in children under 5 years of age globally. To improve the management of CAP, we must distinguish CAP from other common pediatric conditions and develop better diagnostic methods to detect the causative organism, so as to best direct appropriate resources in both industrialized and developing countries. Here, we review the diagnostic modalities available for identifying viruses and bacteria in the upper and lower respiratory tract of children, with a discussion of their utility and limitations in diagnosing CAP in children.
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Affiliation(s)
- C M C Rodrigues
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Department of Paediatric Infectious Diseases and Immunology, Great North Children's Hospital, Newcastle Upon Tyne, United Kingdom
| | - H Groves
- Centre for Experimental Medicine, Queens University, Belfast, United Kingdom
- Department of Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
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Iroh Tam PY, Sadoh AE, Obaro SK. A meta-analysis of antimicrobial susceptibility profiles for pneumococcal pneumonia in sub-Saharan Africa. Paediatr Int Child Health 2018; 38:7-15. [PMID: 28453405 DOI: 10.1080/20469047.2017.1298700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pneumonia causes an enormous burden of childhood disease globally, particularly in low- and middle-income countries. Pneumococcus is the most common bacterial aetiology of pneumonia; however, antimicrobials are limited and may not adequately address the local epidemiology of the region. AIM To undertake a review and meta-analysis of pneumonia studies in sub-Saharan Africa to evaluate antimicrobial susceptibility patterns in childhood pneumonia. METHODS Articles published in PubMed and Google between 2006 and 2016 which evaluated antimicrobial susceptibility profiles of pneumococcal pneumonia in children in sub-Saharan Africa were identified. The source of specimens, pathogens and antimicrobial susceptibility data were extracted. Pooled analysis of susceptible isolates was conducted using random effects models. RESULTS Children from 15 studies and 1634 isolates were included in the meta-analysis. In cases of childhood pneumonia, the mean overall proportion of penicillin susceptibility from invasive specimens of Streptococcus pneumoniae was 85.7% (95% CI 80.1-91.3), and of trimethoprim-sulfamethoxazole was 21.0% (95% CI 5.1-36.9). Compared with all S. pneumoniae specimens, penicillin susceptibility was 68.6% (95% CI 59.6-77.5) and that of trimethoprim-sulfamethoxazole was 26.3% (95% CI 14.1-38.6). CONCLUSIONS A high level of heterogeneity was detected, reflecting the paucity of data available. The establishment of national and regional diagnostic platforms to monitor antimicrobial susceptibility profiles for pneumonia as well as other invasive diseases will provide data with which to assess the relevance and adaptation of antimicrobial prescribing recommendations.
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Affiliation(s)
- Pui-Ying Iroh Tam
- a Department of Pediatrics , University of Minnesota , Minneapolis , MN , USA
| | - Ayebo E Sadoh
- b Department of Pediatrics , University of Nebraska , Omaha , NE , USA
| | - Stephen K Obaro
- b Department of Pediatrics , University of Nebraska , Omaha , NE , USA
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Katz SE, Williams DJ. Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research. Infect Dis Clin North Am 2017; 32:47-63. [PMID: 29269189 PMCID: PMC5801082 DOI: 10.1016/j.idc.2017.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Community-acquired pneumonia (CAP) is one of the most common serious infections in childhood. This review focuses on pediatric CAP in the United States and other industrialized nations, specifically highlighting the changing epidemiology of CAP, diagnostic and therapeutic challenges, and areas for further research.
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Affiliation(s)
- Sophie E Katz
- Division of Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, D-7235 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232-2581, USA
| | - Derek J Williams
- Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, CCC 5324 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA.
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36
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Vasconcellos ÂG, Clarêncio J, Andrade D, Cardoso MRA, Barral A, Nascimento-Carvalho CM. Systemic cytokines and chemokines on admission of children hospitalized with community-acquired pneumonia. Cytokine 2017; 107:1-8. [PMID: 29158121 DOI: 10.1016/j.cyto.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/29/2022]
Abstract
Community-acquired pneumonia (CAP) is the main cause of death in children under-5 years worldwide and Streptococcus pneumoniae is the most common bacterial agent. However, it is difficult to identify pneumococcal infection among children with CAP. We aimed to assess association between any cytokine/chemokine and pneumococcal infection in childhood CAP. Furthermore, we evaluated the diagnostic value of cytokine/chemokine for pneumococcal infection. This prospective study was conducted at an Emergency Room, in Salvador, Brazil. Children <5-years-old hospitalized with CAP in a 21-month period were evaluated. On admission, clinical and radiological data were collected along with biological samples to investigate 20 etiological agents and determine serum cytokines (interleukin (IL)-8, IL-6, IL-10, IL-1β, IL-12, TNF-α, IL-2, IL-4, IL-5, γ-interferon), and chemokines (CCL2, CCL5, CXCL9, CXCL10) concentration. From 166 patients with etiology detected, pneumococcal infection was detected in 38 (22.9%) cases among which the median IL-6(pg/ml) was 31.2 (IQR: 12.4-54.1). The other 128 cases had other causative agents detected (Haemophilus influenzae, Moraxella catarrhalis, atypical bacteria and viruses) with the median IL-6 concentration being 9.0 (IQR: 4.1-22.0; p < 0.001). The area under the ROC curve for IL-6 to predict pneumococcal CAP was 0.74 (95%CI: 0.65-0.83; p < 0.001). By multivariate analysis, with pneumococcal CAP as dependent variable, IL-6 was an independent predictor for pneumococcal infection (OR = 5.56; 95%CI: 2.42-12.75, cut-off point = 12.5 pg/ml; p = 0.0001). The negative predictive value of IL-6 under 12.5 pg/ml for pneumococcal infection was 90% (95%CI: 82-95%). Independently significant difference was not found for any other cytokines/chemokines. Serum IL-6 concentration on admission is independently associated with pneumococcal infection among children under-5 years hospitalized with CAP.
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Affiliation(s)
- Ângela G Vasconcellos
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil.
| | - Jorge Clarêncio
- Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Daniela Andrade
- Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | | | - Aldina Barral
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil; Centro de Pesquisa Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Cristiana M Nascimento-Carvalho
- Postgraduate Program in Health Sciences, Federal University of Bahia School of Medicine, Salvador, Brazil; Department of Pediatrics, Federal University of Bahia School of Medicine, Salvador, Brazil.
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Messinger AI, Kupfer O, Hurst A, Parker S. Management of Pediatric Community-acquired Bacterial Pneumonia. Pediatr Rev 2017; 38:394-409. [PMID: 28864731 DOI: 10.1542/pir.2016-0183] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Amanda Hurst
- Department of Pharmacy, Children's Hospital Colorado, Aurora, CO
| | - Sarah Parker
- Infectious Diseases, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, CO
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Neuman MI, Hall M, Lipsett SC, Hersh AL, Williams DJ, Gerber JS, Brogan TV, Blaschke AJ, Grijalva CG, Parikh K, Ambroggio L, Shah SS. Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia. Pediatrics 2017; 140:peds.2017-1013. [PMID: 28835382 PMCID: PMC5574722 DOI: 10.1542/peds.2017-1013] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES National guidelines recommend blood cultures for children hospitalized with presumed bacterial community-acquired pneumonia (CAP) that is moderate or severe. We sought to determine the prevalence of bacteremia and characterize the microbiology and penicillin-susceptibility patterns of positive blood culture results among children hospitalized with CAP. METHODS We conducted a cross-sectional study of children hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We included children 3 months to 18 years of age with discharge diagnosis codes for CAP using a previously validated algorithm. We excluded children with complex chronic conditions. We reviewed microbiologic data and classified positive blood culture detections as pathogens or contaminants. Antibiotic-susceptibility patterns were assessed for all pathogens. RESULTS A total of 7509 children hospitalized with CAP were included over the 5-year study period. Overall, 34% of the children hospitalized with CAP had a blood culture performed; 65 (2.5% of patients with blood cultures; 95% confidence interval [CI]: 2.0%-3.2%) grew a pathogen. Streptococcus pneumoniae accounted for 78% of all detected pathogens. Among detected pathogens, 50 (82%) were susceptible to penicillin. Eleven children demonstrated growth of an organism nonsusceptible to penicillin, representing 0.43% (95% CI: 0.23%-0.77%) of children with blood cultures obtained and 0.15% (95% CI: 0.08%-0.26%) of all children hospitalized with CAP. CONCLUSIONS Among children without comorbidities hospitalized with CAP in a non-ICU setting, the rate of bacteremia was low, and isolated pathogens were usually susceptible to penicillin. Blood cultures may not be needed for most children hospitalized with CAP.
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Affiliation(s)
- Mark I. Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Susan C. Lipsett
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Adam L. Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Derek J. Williams
- Division of Hospital Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, and,Departments of Pediatrics and
| | - Jeffrey S. Gerber
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas V. Brogan
- Division of Critical Care, Seattle Children’s Hospital, Seattle, Washington;,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Anne J. Blaschke
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Carlos G. Grijalva
- Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Medical Center, Washington, District of Columbia;,Department of Pediatrics, School of Medicine, George Washington University, Washington, District of Columbia
| | - Lilliam Ambroggio
- Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Samir S. Shah
- Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Geoghegan S, Erviti A, Caballero MT, Vallone F, Zanone SM, Losada JV, Bianchi A, Acosta PL, Talarico LB, Ferretti A, Grimaldi LA, Sancilio A, Dueñas K, Sastre G, Rodriguez A, Ferrero F, Barboza E, Gago GF, Nocito C, Flamenco E, Perez AR, Rebec B, Ferolla FM, Libster R, Karron RA, Bergel E, Polack FP. Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors. Am J Respir Crit Care Med 2017; 195:96-103. [PMID: 27331632 DOI: 10.1164/rccm.201603-0658oc] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
RATIONALE Respiratory syncytial virus (RSV) is the most frequent cause of hospitalization and an important cause of death in infants in the developing world. The relative contribution of social, biologic, and clinical risk factors to RSV mortality in low-income regions is unclear. OBJECTIVES To determine the burden and risk factors for mortality due to RSV in a low-income population of 84,840 infants. METHODS This was a prospective, population-based, cross-sectional, multicenter study conducted between 2011 and 2013. Hospitalizations and deaths due to severe lower respiratory tract illness (LRTI) were recorded during the RSV season. All-cause hospital deaths and community deaths were monitored. Risk factors for respiratory failure (RF) and mortality due to RSV were assessed using a hierarchical, logistic regression model. MEASUREMENTS AND MAIN RESULTS A total of 2,588 (65.5%) infants with severe LRTI were infected with RSV. A total of 157 infants (148 postneonatal) experienced RF or died with RSV. RSV LRTI accounted for 57% fatal LRTI tested for the virus. A diagnosis of sepsis (odds ratio [OR], 17.03; 95% confidence interval [CI], 13.14-21.16 for RF) (OR, 119.39; 95% CI, 50.98-273.34 for death) and pneumothorax (OR, 17.15; 95% CI, 13.07-21.01 for RF) (OR, 65.49; 95% CI, 28.90-139.17 for death) were the main determinants of poor outcomes. CONCLUSIONS RSV was the most frequent cause of mortality in low-income postneonatal infants. RF and death due to RSV LRTI, almost exclusively associated with prematurity and cardiopulmonary diseases in industrialized countries, primarily affect term infants in a developing world environment. Poor outcomes at hospitals are frequent and associated with the cooccurrence of bacterial sepsis and clinically significant pneumothoraxes.
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Affiliation(s)
| | | | | | | | | | - Juan Ves Losada
- 3 Hospital de Alta Complejidad El Cruce "Dr. Néstor Kirchner," Florencio Varela, Argentina
| | | | | | | | | | | | - Andrea Sancilio
- 5 Hospital Interzonal General de Agudos "Evita," Lanús, Argentina
| | - Karina Dueñas
- 5 Hospital Interzonal General de Agudos "Evita," Lanús, Argentina
| | - Gustavo Sastre
- 6 Hospital Zonal General de Agudos Descentralizado "Evita Pueblo," Berazategui, Argentina
| | - Andrea Rodriguez
- 6 Hospital Zonal General de Agudos Descentralizado "Evita Pueblo," Berazategui, Argentina
| | - Fernando Ferrero
- 7 Hospital General de Niños "Pedro de Elizalde," Buenos Aires, Argentina
| | - Edgar Barboza
- 8 Hospital Zonal General de Agudos "Dr. Narciso López," Lanús, Argentina
| | - Guadalupe Fernández Gago
- 9 Institute for Development and Research in Pediatrics "Prof. Dr. Fernando E. Viteri," Children's Hospital of La Plata (Min Sal/CIC-PBA), La Plata, Argentina
| | - Celina Nocito
- 10 Hospital Interzonal General de Agudos "Dr. Pedro Fiorito," Avellaneda, Argentina
| | - Edgardo Flamenco
- 11 Hospital Zonal General de Agudos "Dr. Arturo Oñativia," Rafael Calzada, Argentina
| | | | - Beatriz Rebec
- 13 Hospital Interzonal General de Agudos "Presidente Perón," Avellaneda, Argentina
| | | | | | - Ruth A Karron
- 14 Johns Hopkins University, Baltimore, Maryland; and
| | | | - Fernando P Polack
- 1 Fundación INFANT, Buenos Aires, Argentina.,15 Vanderbilt University, Nashville, Tennessee
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Kwon JH, Kim JH, Lee JY, Kim YJ, Sohn CH, Lim KS, Kim WY. Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department. Medicine (Baltimore) 2017; 96:e7028. [PMID: 28562556 PMCID: PMC5459721 DOI: 10.1097/md.0000000000007028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To investigate the utility of blood cultures performed on previously healthy children and adolescents with community-acquired pneumonia (CAP) at a tertiary care hospital emergency department (ED).We reviewed 3235 patients with CAP aged 6 months to 18 years who underwent blood cultures at the ED from 2009 through 2016. CAP was defined according to the International Classification of Diseases, 10th Revision codes for pneumonia and the requirement of antibiotic treatment plus any of the following: radiologically confirmed, hospitalized, or moderate to severe disease. Blood cultures were retrospectively justified by the Infectious Diseases Society of America guidelines. We measured the yield (true positive results of blood culture) and impact (blood culture-directed change in the antibiotic regimen).Of 2705 previously healthy patients with CAP, 833 (30.8%; 95% confidence interval [CI]: 29.1-32.6) underwent blood cultures justified by the current guidelines. We found 12 patients (0.4%; 95% CI: 0.2-0.8) having positive results of blood culture, 7 of whom underwent justified blood cultures. Of these 7 patients, 3 (0.11%; 95% CI: 0.02-0.3) had the yield, Streptococcus pneumoniae. No impact was made in these 3 patients with S pneumoniae.We confirmed a low utility of blood cultures in previously healthy children and adolescents with CAP who were admitted to the ED. This finding suggests the need to refine the current guidelines for obtaining blood cultures in the ED for pediatric CAP.
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Affiliation(s)
- Jae Hyun Kwon
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center
| | - Jung Heon Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Childhood pneumococcal disease in Africa - A systematic review and meta-analysis of incidence, serotype distribution, and antimicrobial susceptibility. Vaccine 2017; 35:1817-1827. [PMID: 28284682 DOI: 10.1016/j.vaccine.2017.02.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/30/2017] [Accepted: 02/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV). METHODS To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000 to 2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models. RESULTS We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively. CONCLUSIONS Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.
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Lappin M, Blondeau J, Boothe D, Breitschwerdt E, Guardabassi L, Lloyd D, Papich M, Rankin S, Sykes J, Turnidge J, Weese J. Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med 2017; 31:279-294. [PMID: 28185306 PMCID: PMC5354050 DOI: 10.1111/jvim.14627] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 09/05/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022] Open
Abstract
Respiratory tract disease can be associated with primary or secondary bacterial infections in dogs and cats and is a common reason for use and potential misuse, improper use, and overuse of antimicrobials. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, the International Society for Companion Animal Infectious Diseases convened a Working Group of clinical microbiologists, pharmacologists, and internists to share experiences, examine scientific data, review clinical trials, and develop these guidelines to assist veterinarians in making antimicrobial treatment choices for use in the management of bacterial respiratory diseases in dogs and cats.
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Affiliation(s)
- M.R. Lappin
- Colorado State UniversityFort CollinsCODenmark
| | | | | | | | | | | | - M.G. Papich
- North Carolina State UniversityRaleighNCDenmark
| | - S.C. Rankin
- University of PennsylvaniaPhiladelphiaPAAustralia
| | - J.E. Sykes
- University of CaliforniaDavisCAAustralia
| | - J. Turnidge
- The Women's and Children HospitalAdelaideSA,Australia
| | - J.S. Weese
- Ontario Veterinary CollegeGuelphONAustralia
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43
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Davis TR, Evans HR, Murtas J, Weisman A, Francis JL, Khan A. Utility of blood cultures in children admitted to hospital with community-acquired pneumonia. J Paediatr Child Health 2017; 53:232-236. [PMID: 27714962 DOI: 10.1111/jpc.13376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/08/2016] [Accepted: 08/23/2016] [Indexed: 10/20/2022]
Abstract
AIM The aim of the study was to assess the utility of blood cultures in children admitted to hospital with community-acquired pneumonia. The primary outcome was the number of positive blood culture results, and secondary outcomes included the effect of positive blood culture results on management, and the identification of other clinical/biochemical variables that could predict blood culture results or the course of illness. METHODS A retrospective data analysis was carried out on all children admitted to Gosford Hospital during the 2-year period from July 2013 to June 2015. Included were patients under 16 years old who had a diagnosis-related group code of pneumonia. A review of blood culture results, chest X-ray, serology, C-reactive protein and white cell count and clinical outcomes were analysed. RESULTS There were 215 paediatric admissions with a diagnosis of pneumonia during the 2-year study period. A blood culture was collected in 82.3% (177/215). Although seven had a positive blood culture, only two of these were finally reported as true positives and both were Streptococcus pneumoniae. Both patients were treated with a cephalosporin and demonstrated clinical improvement. No changes were made to their treatment based on the blood culture results. CONCLUSION Blood cultures have a low yield and do not appear to be helpful when collected in all patients admitted to hospital with community-acquired pneumonia.
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Affiliation(s)
- Tessa R Davis
- Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Hannah R Evans
- Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jennifer Murtas
- Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Aimee Weisman
- Department of Paediatrics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - J Lynn Francis
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Teaching and Research Unit, Central Coast Local Health District, Gosford, New South Wales, Australia
| | - Ahmed Khan
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Paediatrics, Gosford Hospital, Gosford, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW This review covers the outpatient management of pediatric community-acquired pneumonia (CAP), discussing the changing microbiology of CAP since the introduction of the 13-valent pneumococcal conjugate vaccine in 2010, and providing an overview of national guideline recommendations for diagnostic evaluation and treatment. RECENT FINDINGS Rates of invasive pneumococcal disease and pneumococcal antibiotic resistance have plummeted since widespread 13-valent pneumococcal conjugate vaccine immunization. Viruses remain the most common cause of CAP in young children; children over age 5 years have increased rates of Mycoplasma pneumoniae. A recent national guideline offers recommendations for office-based diagnostic evaluation and treatment of pediatric CAP. SUMMARY This review offers a discussion of the above findings with practical recommendations for the office-based practitioner in the evaluation and treatment of an infant (>3 months) or child with suspected CAP.
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Herberg JA, Kaforou M, Wright VJ, Shailes H, Eleftherohorinou H, Hoggart CJ, Cebey-Lopez M, Carter MJ, Janes VA, Gormley S, Shimizu C, Tremoulet AH, Barendregt AM, Salas A, Kanegaye J, Pollard AJ, Faust SN, Patel S, Kuijpers T, Martinon-Torres F, Burns JC, Coin LJM, Levin M. Diagnostic Test Accuracy of a 2-Transcript Host RNA Signature for Discriminating Bacterial vs Viral Infection in Febrile Children. JAMA 2016; 316:835-45. [PMID: 27552617 PMCID: PMC5997174 DOI: 10.1001/jama.2016.11236] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Because clinical features do not reliably distinguish bacterial from viral infection, many children worldwide receive unnecessary antibiotic treatment, while bacterial infection is missed in others. OBJECTIVE To identify a blood RNA expression signature that distinguishes bacterial from viral infection in febrile children. DESIGN, SETTING, AND PARTICIPANTS Febrile children presenting to participating hospitals in the United Kingdom, Spain, the Netherlands, and the United States between 2009-2013 were prospectively recruited, comprising a discovery group and validation group. Each group was classified after microbiological investigation as having definite bacterial infection, definite viral infection, or indeterminate infection. RNA expression signatures distinguishing definite bacterial from viral infection were identified in the discovery group and diagnostic performance assessed in the validation group. Additional validation was undertaken in separate studies of children with meningococcal disease (n = 24) and inflammatory diseases (n = 48) and on published gene expression datasets. EXPOSURES A 2-transcript RNA expression signature distinguishing bacterial infection from viral infection was evaluated against clinical and microbiological diagnosis. MAIN OUTCOMES AND MEASURES Definite bacterial and viral infection was confirmed by culture or molecular detection of the pathogens. Performance of the RNA signature was evaluated in the definite bacterial and viral group and in the indeterminate infection group. RESULTS The discovery group of 240 children (median age, 19 months; 62% male) included 52 with definite bacterial infection, of whom 36 (69%) required intensive care, and 92 with definite viral infection, of whom 32 (35%) required intensive care. Ninety-six children had indeterminate infection. Analysis of RNA expression data identified a 38-transcript signature distinguishing bacterial from viral infection. A smaller (2-transcript) signature (FAM89A and IFI44L) was identified by removing highly correlated transcripts. When this 2-transcript signature was implemented as a disease risk score in the validation group (130 children, with 23 definite bacterial, 28 definite viral, and 79 indeterminate infections; median age, 17 months; 57% male), all 23 patients with microbiologically confirmed definite bacterial infection were classified as bacterial (sensitivity, 100% [95% CI, 100%-100%]) and 27 of 28 patients with definite viral infection were classified as viral (specificity, 96.4% [95% CI, 89.3%-100%]). When applied to additional validation datasets from patients with meningococcal and inflammatory diseases, bacterial infection was identified with a sensitivity of 91.7% (95% CI, 79.2%-100%) and 90.0% (95% CI, 70.0%-100%), respectively, and with specificity of 96.0% (95% CI, 88.0%-100%) and 95.8% (95% CI, 89.6%-100%). Of the children in the indeterminate groups, 46.3% (63/136) were classified as having bacterial infection, although 94.9% (129/136) received antibiotic treatment. CONCLUSIONS AND RELEVANCE This study provides preliminary data regarding test accuracy of a 2-transcript host RNA signature discriminating bacterial from viral infection in febrile children. Further studies are needed in diverse groups of patients to assess accuracy and clinical utility of this test in different clinical settings.
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Affiliation(s)
- Jethro A Herberg
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Myrsini Kaforou
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Victoria J Wright
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Hannah Shailes
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Hariklia Eleftherohorinou
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Clive J Hoggart
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Miriam Cebey-Lopez
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
| | - Michael J Carter
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Victoria A Janes
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Stuart Gormley
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Chisato Shimizu
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Anouk M Barendregt
- Emma Children’s Hospital, Department of Paediatric Haematology, Immunology & Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Salas
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
- Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, and Instituto de Ciencias Forenses, Grupo de Medicina Xenómica, Spain
| | - John Kanegaye
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Saul N Faust
- NIHR Wellcome Trust Clinical Research Facility, University of Southampton UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Taco Kuijpers
- Emma Children’s Hospital, Department of Paediatric Haematology, Immunology & Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinon-Torres
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Lachlan JM Coin
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - Michael Levin
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
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Iroh Tam PY, Obaro SK, Storch G. Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries. J Pediatric Infect Dis Soc 2016; 5:190-205. [PMID: 27059657 PMCID: PMC7107506 DOI: 10.1093/jpids/piw016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Acute febrile illness is a common cause of hospital admission, and its associated infectious causes contribute to substantial morbidity and death among children worldwide, especially in low- and middle-income countries. Declining transmission of malaria in many regions, combined with the increasing use of rapid diagnostic tests for malaria, has led to the increasing recognition of leptospirosis, rickettsioses, respiratory viruses, and arboviruses as etiologic agents of fevers. However, clinical discrimination between these etiologies can be difficult. Overtreatment with antimalarial drugs is common, even in the setting of a negative test result, as is overtreatment with empiric antibacterial drugs. Viral etiologies remain underrecognized and poorly investigated. More-sensitive diagnostics have led to additional dilemmas in discriminating whether a positive test result reflects a causative pathogen. Here, we review and summarize the current epidemiology and focus particularly on children and the challenges for future research.
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Affiliation(s)
- Pui-Ying Iroh Tam
- Department of Pediatrics
,
University of Minnesota Medical School
,
Minneapolis,Corresponding Author:
Pui-Ying Iroh Tam, MD, 3-210 MTRF, 2001 6th St. SE, Minneapolis, MN 55455. E-mail:
| | - Stephen K. Obaro
- Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | - Gregory Storch
- Department of Pediatrics
,
Washington University School of Medicine
,
St Louis, Missouri
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47
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McCulloh RJ. Targeted blood culture testing in pediatric community-acquired pneumonia. J Pediatr 2016; 172:224-7. [PMID: 27112087 DOI: 10.1016/j.jpeds.2016.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Abstract
Community-acquired pneumonia (CAP) is the most common acute infectious cause of death in children worldwide. Consequently, research into the epidemiology, diagnosis, treatment, and prevention of pediatric CAP spans the translational research spectrum. Herein, we aim to review the most significant findings reported by investigators focused on pediatric CAP research that has been reported in 2014 and 2015. Our review focuses on several key areas relevant to the clinical management of CAP. First, we will review recent advances in the understanding of CAP epidemiology worldwide, including the role of vaccination in the prevention of pediatric CAP. We also report on the expanding role of existing and emerging diagnostic technologies in CAP classification and management, as well as advances in optimizing antimicrobial use. Finally, we will review CAP management from the policy and future endeavors standpoint, including the influence of clinical practice guidelines on clinician management and patient outcomes, and future potential research directions that are in the early stages of investigation.
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Tief F, Hoppe C, Seeber L, Obermeier P, Chen X, Karsch K, Mühlhans S, Adamou E, Conrad T, Beresniak A, Schweiger B, Adam T, Rath B. An inception cohort study assessing the role of pneumococcal and other bacterial pathogens in children with influenza and ILI and a clinical decision model for stringent antibiotic use. Antivir Ther 2016; 21:413-24. [PMID: 26867096 DOI: 10.3851/imp3034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Influenza-like illness (ILI) is a common reason for paediatric consultations. Viral causes predominate, but antibiotics are used frequently. With regard to influenza, pneumococcal coinfections are considered major contributors to morbidity/mortality. METHODS In the context of a perennial quality management (QM) programme at the Charité Departments of Paediatrics and Microbiology in collaboration with the Robert Koch Institute, children aged 0-18 years presenting with signs and symptoms of ILI were followed from the time of initial presentation until hospital discharge (Charité Influenza-Like Disease = ChILD Cohort). An independent QM team performed highly standardized clinical assessments using a disease severity score based on World Health Organization criteria for uncomplicated and complicated/progressive disease. Nasopharyngeal and pharyngeal samples were collected for viral reverse transcription polymerase chain reaction and bacterial culture/sensitivity and MaldiTOF analyses. The term 'detection' was used to denote any evidence of viral or bacterial pathogens in the (naso)pharyngeal cavity. With the ChILD Cohort data collected, a standard operating procedure (SOP) was created as a model system to reduce the inappropriate use of antibiotics in children with ILI. Monte Carlo simulations were performed to assess cost-effectiveness. RESULTS Among 2,569 ChILD Cohort patients enrolled from 12/2010 to 04/2013 (55% male, mean age 3.2 years, range 0-18, 19% >5 years), 411 patients showed laboratory-confirmed influenza, with bacterial co-detection in 35%. Influenza and pneumococcus were detected simultaneously in 12/2,569 patients, with disease severity clearly below average. Pneumococcal vaccination rates were close to 90%. Nonetheless, every fifth patient was already on antibiotics upon presentation; new antibiotic prescriptions were issued in an additional 20%. Simulation of the model SOP in the same dataset revealed that the proposed decision model could have reduced the inappropriate use of antibiotics significantly (P<0.01) with an incremental cost-effectiveness ratio of -99.55€. CONCLUSIONS Physicians should be made aware that in times of pneumococcal vaccination the prevalence and severity of influenza infections complicated by pneumococci may decline. Microbiological testing in combination with standardized disease severity assessments and review of vaccination records could be cost-effective, as well as promoting stringent use of antibiotics and a personalized approach to managing children with ILI.
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Affiliation(s)
- Franziska Tief
- Department of Paediatrics, Charité University Medical Centre Berlin, Berlin, Germany
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