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Published on: June 28, 2018
Paediatric critical illness associated with respiratory infection: a single-centre, retrospective cohort study
Haifa Alfaraidi1, Kathy Luinstra2, Alireza Eshaghi3
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Mycoplasma pneumoniae infections are common in critically ill children with pneumonia, particularly older school-aged children. Early diagnosis and targeted antibiotic treatment are crucial for better outcomes in pediatric respiratory infections.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Respiratory medicine
Background:
- Critically ill children with respiratory infections present diverse clinical syndromes.
- Identifying causative pathogens is essential for appropriate management and reducing morbidity.
- The role of Mycoplasma pneumoniae in severe pediatric respiratory infections requires further elucidation.
Purpose of the Study:
- To characterize critically ill children with respiratory infections.
- To classify these children based on their specific infection syndrome.
- To determine the prevalence of Mycoplasma pneumoniae detection in this cohort.
Main Methods:
- A retrospective cohort study was conducted in a tertiary hospital's pediatric intensive care unit (PICU).
- Children aged 2 months to 18 years with presumed respiratory infections were included.
- Nasopharyngeal swabs were tested for respiratory viruses, Mycoplasma pneumoniae, and Chlamydia pneumoniae.
Main Results:
- Out of 221 subjects, 4.5% tested positive for Mycoplasma pneumoniae.
- Mycoplasma-positive children were older and had fewer viral coinfections.
- Prevalence of Mycoplasma infection was 13.2% in children over 5 years with pneumonia.
Conclusions:
- Respiratory viruses were common, and broad-spectrum antibiotics were frequently used.
- Mycoplasma pneumoniae infection is a significant finding in school-aged children with pneumonia admitted to the PICU.
- Consideration of rapid Mycoplasma diagnostics and optimized antibiotic therapy is recommended for critically ill children.
Objectives:
To describe critically ill children with respiratory infections, classify them by infection syndrome type and determine the prevalence of Mycoplasma pneumoniae detection.
Study Design:
A retrospective, single-centre cohort study. All children aged 2 months-18 years with presumed respiratory infection who were admitted to a tertiary hospital paediatric intensive care unit (PICU) between September 2015 and October 2016 were eligible. Subjects were grouped by clinical syndrome (viral respiratory infection, asthma exacerbation, undifferentiated/uncomplicated pneumonia, pneumonia complicated by effusion/empyema and 'other'). All subjects had nasopharyngeal swabs tested for respiratory viruses, M. pneumoniae and Chlamydia pneumoniae.
Results:
There were 221 subjects; the median age was 3.1 years; 44% were female; and 78% had medical comorbidities. The majority (75%) was treated with antibiotics, most often ceftriaxone (90% of treated children). Those with any pneumonia were significantly less likely to have a respiratory virus identified in their nasopharynges and had significantly higher C reactive protein (CRP) values than those in the viral infection and asthma groups. There were 10 subjects in whom M. pneumoniae was detected (4.5%, 95% CI 2.2% to 8.2%). Mycoplasma-positive children were older (difference 3.5 years, 95% CI 0.66 to 6.4 years) and had fewer viral coinfections (30% compared with 69%, p=0.02). The prevalence of Mycoplasma infection in children aged >5 years with any pneumonia was 13.2% (95%CI 4.4% to 28%).
Conclusions:
The majority of participants had respiratory viruses detected and were treated with broad-spectrum antibiotics. Differences in CRP and viral prevalence were observed between children with different infection syndrome types. M. pneumoniae infection was not rare in school-aged children with pneumonia admitted to the PICU. Attention to antibiotic treatment and rapid diagnostic testing for Mycoplasma in older, critically ill children should be considered to optimise management and avert morbidity and mortality from respiratory infection.
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