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Madhi F, Panetta L, De Pontual L, Biscardi S, Remus N, Gillet Y, Gajdos V, Ros B, Angoulvant F, Dutron S, Cohen R. Antimicrobial treatment of lower respiratory tract infections in children. Infect Dis Now 2023; 53:104782. [PMID: 37714411 DOI: 10.1016/j.idnow.2023.104782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
Lower respiratory tract infections (LRTI) encompass a wide range of clinical syndromes, prominently including bronchiolitis, bronchitis and pneumonia. LRTIs are the second leading cause of antibiotic prescriptions. The vast majority of these infections are due to (or triggered by) viruses and are self-limited diseases. Pneumonia in children is responsible for significant morbidity and mortality worldwide. For clinicians, one of the main difficulties consists in diagnosing pneumonia in febrile children with (or without) cough. The diagnosis is given on the basis of anamnesis, clinical examination and (if necessary) complementary examinations, with chest X-ray or thoracic ultrasound; biological markers are particularly important. Over recent years, since the implementation of PCV13, the bacterial epidemiology of pneumonia and empyema has evolved; involvement in these diseases of pneumococcus has been reduced, and resistance to penicillin has lessened - and remained extremely low. In 2021, according to the National Pneumococcal Reference Center, only 6% of the strains isolated from blood cultures in children are resistant to amoxicillin. The therapeutic choices proposed in this article are in full compliance with the previously published official French recommendations.
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Affiliation(s)
- Fouad Madhi
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luc Panetta
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, HFME Lyon, France
| | - Loic De Pontual
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Jean Verdier Hospital, Bondy, France
| | - Sandra Biscardi
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Natacha Remus
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Yves Gillet
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Pediatric Emergency Room, HFME Lyon, France
| | - Vincent Gajdos
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of Pediatrics, Antoine Béclère Hospital, Clamart, France
| | - Barbara Ros
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Neonatal and Pediatric Intensive Care Unit, University Hospital of Bordeaux, Bordeaux, France
| | - François Angoulvant
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of General Pediatrics, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sarah Dutron
- Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Department of Pediatrics, Centre Hospitalier de Montpellier, Montpellier, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Pediatric Infectious Pathology Group of the French Pediatric Society (GPIP), France; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil.
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Farida H, Triasih R, Lokida D, Mardian Y, Salim G, Wulan WN, Butar-butar DP, Sari RA, Budiman A, Hayuningsih C, Anam MS, Dipayana S, Mujahidah M, Setyati A, Aman AT, Naysilla AM, Lukman N, Diana A, Karyana M, Kline A, Neal A, Lane HC, Kosasih H, Lau CY. Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia. Front Med (Lausanne) 2023; 10:1140100. [PMID: 37275364 PMCID: PMC10233046 DOI: 10.3389/fmed.2023.1140100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Background Discrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP. Methods Data from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression. Results Diarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia's rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08-0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18-18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07-25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively. Conclusion Combining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.
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Affiliation(s)
- Helmia Farida
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Rina Triasih
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dewi Lokida
- Tangerang District General Hospital, Tangerang, Indonesia
| | - Yan Mardian
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Gustiani Salim
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Wahyu Nawang Wulan
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | | | - Rizki Amalia Sari
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Arif Budiman
- Tangerang District General Hospital, Tangerang, Indonesia
| | | | - Moh Syarofil Anam
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Setya Dipayana
- Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, Indonesia
| | - Mujahidah Mujahidah
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Amalia Setyati
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abu Tholib Aman
- Rumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Nurhayati Lukman
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Aly Diana
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Muhammad Karyana
- National Institute of Health Research and Development, Ministry of Health Republic of Indonesia, Jakarta, Indonesia
| | - Ahnika Kline
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
| | - Chuen-Yen Lau
- National Cancer Institute, Bethesda, MD, United States
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Taşar S, Fidancı İ, Bulut İ, Kırtıl G, Saç RÜ, Taşar MA. Role of Serum Endocan Levels in Children with Bacterial and Viral Pneumonia: A Prospective, Case-Control Study. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:145-152. [PMID: 36454243 DOI: 10.1089/ped.2022.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction and Objective: Endocan has been used as a biomarker in the differential diagnosis of pulmonary diseases in adults. However, there are only a limited number of studies on its use in children. In this context, the objective of this study is to evaluate the relationship between serum endocan levels in children with bacterial and viral pneumonia. Materials and Methods: The population of this prospective case-control study consisted of hospitalized children aged 1 month to 15 years diagnosed with pneumonia between August 2020 and July 2021, whereas the control group consisted of randomly selected healthy children. The demographic and clinical characteristics of all participants were recorded. Participants' endocan levels, white blood cell (WBC) and neutrophil counts, and C-reactive protein (CRP) and procalcitonin (PCT) levels were measured within the scope of the laboratory tests. Results: The study sample consisted of 41 children, of whom 21 had bacterial pneumonia and 20 had viral pneumonia, whereas the control group consisted of 47 healthy children. Serum endocan levels, WBC and neutrophil counts, and PCT and CRP levels were significantly higher in children with bacterial pneumonia than in children with viral pneumonia and healthy children (P < 0.05). Additionally, serum endocan levels were significantly higher in children with viral pneumonia than in healthy children (P < 0.001). The endocan levels in children with bacterial pneumonia were significantly associated with the need for intensive care (P = 0.004) and correlated with the length of hospital stay (LoS) (r = 0.592, P = 0.005). Conclusion: The findings of this study indicated that serum endocan levels can be used in the differential diagnosis of bacterial and viral pneumonias. Additionally, it was found that the need for intensive care and LoS were significantly correlated with endocan levels in children with bacterial pneumonia.
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Affiliation(s)
- Serçin Taşar
- Department of Pediatrics, SBU Ankara Training and Research Hospital, Ankara, Turkey
| | - İlknur Fidancı
- Department of Pediatric Emergency, SBU Ankara Training and Research Hospital, Ankara, Turkey
| | - İsmail Bulut
- Department of Pediatrics, SBU Ankara Training and Research Hospital, Ankara, Turkey
| | - Gül Kırtıl
- Department of Medical Biochemistry, SBU Ankara Training and Research Hospital, Ankara, Turkey
| | - Rukiye Ünsal Saç
- Department of Pediatrics, SBU Ankara Training and Research Hospital, Ankara, Turkey
| | - Medine Ayşin Taşar
- Department of Pediatric Emergency, SBU Ankara Training and Research Hospital, Ankara, Turkey
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Ratageri VH, Panigatti P, Mukherjee A, Das RR, Goyal JP, Bhat JI, Vyas B, Lodha R, Singhal D, Kumar P, Singh K, Mahapatro S, Charoo BA, Kabra SK, Jat KR. Role of procalcitonin in diagnosis of community acquired pneumonia in Children. BMC Pediatr 2022; 22:217. [PMID: 35443627 PMCID: PMC9020076 DOI: 10.1186/s12887-022-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background The role of serum Procalcitonin (PCT) in adults in diagnosis of Community acquired pneumonia (CAP) is well established, however, role in pediatric CAP remains controversial. Objectives The objective of this study was to investigate the utility of serum procalcitonin in differentiating bacterial community-acquired lower respiratory tract infection from non-bacterial respiratory infection in children; radiologically confirmed pneumonia was used as the reference. In addition, we assessed the utility of adding the PCT assay to the clinical criteria for diagnosis of pneumonia. Study design Subanalysis of a larger prospective,multicentriccohort study. Participants Children, 2 months to 59 months of age, attending paediatric OPD of 5 urban tertiary care hospitals, suffering from acute respiratory infection (ARI). Intervention Detailed clinical history and examination findings of enrolled children were recorded on predesigned case record form. Samples for PCT were obtained at admission and were measured centrally at the end of the study except for one site using VIDAS® B.R.A.H.M.S PCT kit (Biomerieux SA, France). Outcomes Sensitivity and specificity of procalcitonin for diagnosis of radiologically confirmed pneumonia. Results Serum Procalcitonin was measured in 370 patients; median (IQR) age of these children being 12 (7, 22) months, 235 (63.5%) were boys. The median (IQR) serum procalcitonin concentration was 0.1(0.05, 0.4) ng/mL.Sensitivity and specificity of raised PCT (> 0.5 ng/mL) for pneumonia as per any CXR abnormalities were 29.7% and87.5%,(P < 0.001) respectively. Raised PCT was also significantly associated with consolidation (34.5%,79.2%,P < 0.02)and pleural effusion(54.6%,79%,P < 001). Adding PCT to the existing clinical criteria of WHO did not improve the sensitivity for diagnosis of pneumonia. PCT was significantly higher in children with severe pneumonia. Conclusion Positive PCT (> 0.5 ng/mL) is significantly associated with radiographic pneumonia but not with pneumonia based on WHO criteria.However, it can act as a surrogate marker for severe pneumonia.
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Affiliation(s)
- Vinod H Ratageri
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, 580021, Karnataka, India.
| | - Puspha Panigatti
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, 580021, Karnataka, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Javeed Iqbal Bhat
- Department of Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Bhadresh Vyas
- Department of Pediatrics, MP Shah Medical College, Jamnagar, Gujrat, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Singhal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Samarendra Mahapatro
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Bashir Ahmad Charoo
- Department of Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - K R Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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