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Etiology and Risk Factors Determining Poor Outcome of Severe Pneumonia in Under-Five Children
Suresh Kumar Jakhar1, Mukul Pandey1, Dheeraj Shah2
1Department of Pediatrics, University College of Medical Sciences & GTB Hospital, Dilshad Garden, Delhi, 110095, India.
Insights
Severe pneumonia in children is often caused by Staphylococcus aureus and Streptococcus pneumoniae. Risk factors like rapid breathing and lethargy predict poor outcomes, while wheezing indicates a better prognosis.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Severe pneumonia, characterized by chest indrawing, poses a significant health threat to children under five.
- Identifying etiological agents and risk factors for poor outcomes is crucial for effective management.
Purpose of the Study:
- To determine the causative organisms of severe pneumonia in young children.
- To investigate risk factors associated with adverse outcomes, including treatment failure, antibiotic changes, prolonged hospitalization, mechanical ventilation, and mortality.
Main Methods:
- Prospective enrollment of 120 children (2 months to 5 years) with severe pneumonia.
- Clinical assessment, anthropometry, and microbiological investigations (blood, nasopharyngeal swabs, chest X-ray).
- Logistic regression analysis to evaluate associations between risk factors and recovery outcomes.
Main Results:
- Streptococcus pneumoniae and Staphylococcus aureus were the most common bacteria identified.
- Treatment failure occurred in 12.5%, 28.3% required antibiotic changes, and 41.6% had prolonged hospitalization.
- Risk factors for poor outcomes included rapid respiratory rate, lethargy, inability to drink, abnormal chest X-ray, and positive blood culture; wheezing showed a protective effect.
Conclusions:
- Staphylococcus aureus and Streptococcus pneumoniae are key pathogens in severe pediatric pneumonia.
- Specific clinical and diagnostic factors predict delayed recovery or need for antibiotic adjustment.
- Wheezing may indicate a faster recovery and reduced risk of treatment failure in severe pneumonia.
Objectives:
To determine the etiology of severe pneumonia (pneumonia with chest indrawing) in under-five children, and to study the risk factors for poor outcomes viz., 'treatment failure', 'need for change in antibiotics', 'prolonged hospital stay', 'need for mechanical ventilation' and 'mortality.'
Methods:
Children (age 2 mo to 5 y) with pneumonia and chest drawing were enrolled prospectively from October 2012 through September 2013. Clinical history was recorded, and examination, anthropometry and investigations (including chest X-ray, blood culture and nasopharyngeal swab culture) were performed. Children were managed as per standard guidelines, and recovery outcomes were recorded in form of 'treatment failure' (defined as persistence of features of severe pneumonia after 72 h or worsening of clinical condition before 72 h), need for change of antibiotics and prolonged (>5 d) hospital stay. The associations between the clinical, anthropometric and diagnostic risk factors and the recovery outcomes were evaluated by univariate and multivariate logistic regression analysis.
Results:
Out of 120 children enrolled in the study, 36 (42%) were culture positive (nasopharyngeal/blood); most common bacteria isolated were Streptococcal pneumoniae and Staphylococcal aureus, respectively. Treatment failure was seen in 15 (12.5%), 34 (28.3%) needed change of antibiotics, and 50 (41.6%) children required prolonged hospitalization. Low birth weight, overcrowding, general danger signs (lethargy/unable to drink), clinical rickets, crepitation, leukocytosis and positive blood culture were significant risk factors for treatment failure, prolonged hospital stay and antibiotics change. On multivariate logistic regression analysis, respiratory rate of >70/min (OR 19.94, 95%CI 1.42-280.29), lethargy/unconsciousness (OR 114.2, 95%CI 3.14-4147.92), and positive blood culture (OR 15.24, 95%CI 2.53-91.67) had more chances of treatment failure. Duration of hospital stay was prolonged in those who had inability to drink (OR 3.89, CI 1.37-10.99) or abnormal chest X-ray (OR 8.45, CI 3.56-20.04). Children with rickets (OR 3.69, CI 1.14-11.96), and those with abnormal chest X-ray (OR 9.66, CI 2.62-35.53) had a higher odds of change in antibiotics. Presence of wheeze was a protective factor for treatment failure (OR 0.03, CI 0.00-0.37) and change of antibiotics (OR 0.24, CI 0.07-0.74).
Conclusions:
Staphylococcus aureus and Streptococcus pneumoniae are the predominant organisms causing severe pneumonia in our setting. Children with risk factors such as respiratory rate >70/min, rickets, lethargy/unconsciousness, not able to drink, abnormal chest X-ray or positive blood culture are likely to have a delayed recovery or need of change of antibiotics, whereas those with wheeze are likely to recover faster with less chances of treatment failure.