MICROBIOLOGICAL CHARACTERISTICS OF SEVERE PNEUMONIA IN CHILDREN FROM 2 MONTH TO 24 MONTH HOSPITALIZED AT THE RESPIRATORY DEPARTMENT OF CHILDREN’S HOSPITAL 1
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Abstract
Objective: To compare some of clinical features, laboratory fnding and treament of severe pneumonia caused by bacteria, virus and bacteria-virus coinfections based on PCR (Polymerase Chain Reaction) results NTA (Naso tracheal aspiration), and rapid test to fnding RSV, AdV results in children from 2 months to 24 months hospitalized at the Respiratory Department of Children’s Hospital 1.
Materials and method: A prospective, cross-sectional study with analysis of 138 severe cases of pneumonia requiring oxygen when patients were treated at Respiratory Department Children’s Hospital 1 from 11/2021-8/2022, nasopharyngeal swab was tested for RSV, AdV with rapid test, collecting NTA multi-agent PCR of lower respiratory tract infections and culture as an antibiotic map for microbial pathogens,
Results: During the period from 11/2021 to 8/2022, 138 cases that met the criteria were included in the study. the rate of bacteria infection (+): 21%, virus (+): 6,5%, bacteria-virus coinfections: 68,8%, culture NTA (+): 24,6%, RSV (+) 31,8% and AdV (+) 5,1% were detected in nasopharyngeal swab by on rapid test. Bacteria and virus were detected in PCR NTA: S.pneumoniae 49,8%, MRSA 13,1%, H. influenza non-B 9%, M. cataharrlis 4,9%, M. pneumoniae 5,7%, C. trachomatis 13,1%, CMV 25,3%, RSV 31,8%, Parainfluenzavirus 15,2%, Adenovirus 5,1%, Influenzavirus A 0,7%, Rhinovirus 8,7%, Epstein Barr virus 3,6%, Bocavirus 20,2%. Bacterial infection mainly had fever ≥ 390 C (p=0,000204), SpO2 level < 85% mainly in virus and bacteria-virus coinfections group, severe chest constriction mainly in virus and bacteria-virus coinfections group (p=0,001), main wheeze mainly in the viral group (p=0,00125), the number > 15000TB/mm3 (p=0,047), the number of N ≥ 8000TB/mm3 and the CRP > 35 mg/L mainly in the bacteria group (p=0,021), and the group bacteria-virus coinfections. Chest X-ray focus on one side was mainly in the bacteria group, bilateral infltrative lesions were mainly in the virus group, The virus group was treated mainly for less than 7 days and did not need to change antibiotics, respiratory support was needed NCPAP levels were higher. the bacteria-virus co-infected had more poor initial antibiotic response and longer treatment time.
Conclusions: Bacteria-virus coinfections accounted for a high proportion in pneumonia of children under 2 years of age in S.pneumoniae and RSV infection accounted for the highest rate, pneumonia caused by clinical virus wheezing and respiratory failure more than pneumonia caused by bacteria, bacteria-virus coinfections makes pneumonia less responsive to initial antibiotics and prolonged treatment time. The rapid test for detecting RSV and AdV in thí study has results within 15 minutes and the value is similar to PCR, support the treatment plan after admission, prevent the spread.
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Keywords
Bacterial pneumonia, viral pneumonia, bacteria-virus coinfections pneumonia
References
2. Cao PHG, Pham TMH. Clinical, microbiological and therapeutic characteristics of children with severe pneumonia requiring oxygen at Children’s Hospital 2, Graduation thesis of resident doctors, Ho Chi Minh City Medicine and Pharmacy University 2014.
3. Nguyen NTK, Tran TH, Roberts CL et al. Risk factors for pneumonia. Paediatr Respir Rev 2017;21:95-101. https://doi.org/10.1016/j.prrv.2016.07.002
4. Tran AT. Hospital-acquired respiratory syncytial virus infections in children, Doctoral Thesis in Medicine, University of Medicine and Pharmacy Ho Chi Minh City 2016.
5. Tran AT. Molecular characteristics of respiratory syncytial virus in children with severe lower respiratory infections in communities and hospitals in Ho Chi Minh City. Ho Chi Minh City Medicine 2014;18(4):109-115.
6. Bruning AHL, Leeflanmg MMG, Vos JM et al. Rapid Tests for Influenza, Respiratory Syncytial Virus, and Other Respiratory Viruses: A Systematic Review and Meta-analysis. Clinical Infectious Diseases 2017;65(6):1026-1032. https://doi.org/10.1093/cid/cix461
7. Castro-Rodriguez JA, Daszenies C, Garcia M et al. Adenovirus pneumonia in infants and factors for developing bronchiolitis obliterans: a 5-year follow-up. Pediatr Pulmonol 2014;41(10);947-953.https://doi.org/10.1002/ppul.20472
8. Ensinck G, Lazarte G, Ernst A et al. Community-acquired methicillin-resistant Staphylococcus aureus pneumonia in a children’s hospital. Our ten-year experience. Arch Argent Pediatr 2021;119(1):11-17.https://doi.org/10.5546/aap.2021.eng.11
9. Harris M, Clark J, Coote N et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011;66 Suppl 2:ii1-23. https://doi.org/10.1136/thoraxjnl-2011-200598
10. Le Roux DM, Nicol MP, Vanker A et al. Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa. PloS One 2021;16(8):e0255790. https://doi.org/10.1371/journal.pone.0255790
11. Gonapaladeniya M, Dissanayake T, Liyanage G. Burden of Respiratory Syncytial Virus Associated Severe Pneumonia in Hospitalized Children. International Journal of Pediatrics 2021. https://doi.org/10.1155/2021/8269400
12. Musher DM. Resistance of Streptococcus pneumoniae to beta-lactam antibiotics. www.uptodate.com © 2022 UpToDate, This topic last updated: May 31, 2022.
13. Musher DM. Resistance of Streptococcus pneumoniae to the fluoroquinolones, doxycycline, and trimethoprimsulfamethoxazole. www. uptodate.com © 2022 UpToDate, This topic last updated: Jul 11, 2022.
14. Musher DM. Resistance of Streptococcus pneumoniae to the macrolides, azalides, lincosamides, and ketolides. www.uptodate. com © 2022 UpToDate, This topic last updated: Jun 02, 2022.
15. Pacheco GA, Gálvez NMS, Soto JA et al. Bacterial and Viral Coinfections with the Human Respiratory Syncytial Virus. Microorganisms 2021;9(6):1293. https://doi.org/10.3390/microorganisms9061293
16. Sonego M, Pellegrin MC, Becker G et al. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under fve years of age in low and middle-income countries: a systematic review and metaanalysis of observational studies. PloS one 2015;10(1):116-380. https://doi.org/10.1371/journal.pone.0116380
17. UNICEF. Save the Children, and Every Breath Counts. Every child’s right to survive: a 2020 agenda to end pneumonia deaths”, UNICEF. Available at https://www.unicef.org/reports/every-childs-right-survive-pneumonia.