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Clinical Characteristics and Etiology of Community-acquired Pneumonia in US Children, 2015-2018
Ki Wook Yun1,2, Rebecca Wallihan3, Ankita Desai4
1From the Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Insights
Community-acquired pneumonia (CAP) in children is often caused by viruses like rhinovirus/enterovirus and RSV, and bacteria such as Mycoplasma pneumoniae and Streptococcus pneumoniae. Hospitalization for CAP is linked to symptoms like tachypnea and chest X-ray findings.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Clinical microbiology
Background:
- Community-acquired pneumonia (CAP) significantly impacts child health and healthcare expenses.
- Contemporary data on the clinical features and causes of pediatric CAP are needed.
- This study provides current insights into CAP in U.S. children across inpatient and outpatient settings.
Purpose of the Study:
- To investigate the clinical characteristics of pediatric CAP.
- To determine the etiological agents responsible for CAP in children.
- To compare inpatient and outpatient CAP cases.
Main Methods:
- Prospective, multicenter, observational study conducted in 6 children's hospitals in Ohio (2015-2018).
- Included 441 previously healthy children aged 2 months to 18 years with CAP.
- Pathogen detection via nasopharyngeal swabs, blood, and pleural fluid cultures.
Main Results:
- A pathogen was identified in 64.6% of cases: viruses (55.6%), atypical bacteria (8.8%), and pyogenic bacteria (4.3%).
- Rhinovirus/enterovirus (18.6%) and RSV (16.8%) were the most common viruses; Mycoplasma pneumoniae (8.2%) and Streptococcus pneumoniae (2.3%) were the most common bacteria.
- Inpatients showed higher rates of tachypnea, consolidation, and pleural effusion compared to outpatients.
Conclusions:
- Rhinovirus/enterovirus, RSV, Mycoplasma pneumoniae, and Streptococcus pneumoniae are key pathogens in pediatric CAP.
- Clinical indicators such as tachypnea and radiographic findings are associated with hospitalization for CAP.
- Understanding common pathogens and clinical signs aids in managing pediatric CAP.
Background:
Pneumonia has a major impact on childhood health and health care costs. This study was designed to obtain contemporary information on the clinical characteristics and etiology of community-acquired pneumonia (CAP) in children from both inpatient and outpatient settings in the USA.
Methods:
We conducted a prospective, multicenter, observational study of CAP among previously healthy children 2 months to 18 years of age in 6 children's hospitals in Ohio from 2015 to 2018. For pathogen detection, nasopharyngeal swabs were collected from all subjects. Blood and pleural fluid cultures were available per standard of care.
Results:
We enrolled a convenience sample of 441 patients: 380 hospitalized and 61 outpatients. Tachypnea and radiologic findings of consolidation and pleural effusion were more frequent among inpatients than outpatients. A pathogen was detected in 64.6% of patients: viruses in 55.6%, atypical bacteria in 8.8% and pyogenic bacteria in 4.3%. Eighteen (4.1%) patients had both viruses and bacteria detected. Rhinovirus/enterovirus (RV; 18.6%) and respiratory syncytial virus (RSV; 16.8%) were the viruses most frequently detected, and Mycoplasma pneumoniae (8.2%) and Streptococcus pneumoniae (2.3%) were the most common bacteria. Except for S. pneumoniae, which was identified more frequently in inpatients, there were no significant differences between inpatients and outpatients in the proportions of children with specific pathogens detected.
Conclusions:
Rhinovirus/enterovirus and RSV among viruses and M. pneumoniae and S. pneumoniae among bacteria were the most common pathogens detected in children with CAP. Tachypnea and chest radiographs with consolidation and/or pleural effusion were associated with hospitalization.
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