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Analysis of pathogen distribution and risk factors for extended antibiotic course in children with

Donghai Wang1, Su Yang2, Yajun Mou3

  • 1Department of Respiratory Disease, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents' Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing, China.

Frontiers in Pediatrics
|June 8, 2026
PubMed

Insights

Protracted bacterial bronchitis (PBB) in children is often caused by Streptococcus pneumoniae, requiring longer antibiotic courses. Risk factors for extended treatment include high neutrophils and inhaled corticosteroid use.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Microbiology

Background:

  • Protracted bacterial bronchitis (PBB) studies are limited in low- and middle-income countries.
  • This study investigates PBB outcomes in a large cohort in southwest China.

Purpose of the Study:

  • To determine pathogen distribution in pediatric PBB.
  • To identify risk factors associated with extended antibiotic courses for PBB.

Main Methods:

  • Flexible bronchoscopy was performed on children with PBB.
  • Bronchoalveolar lavage fluid (BALF) analysis included cytology and bacterial culture.
  • Multiple linear regression and decision tree analyses identified predictors of prolonged antibiotic treatment.

Main Results:

  • Streptococcus pneumoniae (Sp) and Haemophilus influenzae (Hi) were the most common pathogens.
  • Sp infection in BALF independently predicted longer antibiotic duration (P=0.013).
  • A decision tree model accurately predicted extended antibiotic courses (>4 weeks) with 87.54% accuracy, based on Sp infection, high neutrophil percentage (>91%), and prior inhaled corticosteroid (ICS) use.

Conclusions:

  • Streptococcus pneumoniae is the primary pathogen in pediatric PBB in this region.
  • A combination of Sp infection, elevated BALF neutrophils, and prior ICS use predicts the need for extended antibiotic therapy.
  • Further research on PBB in low- and middle-income countries is crucial.
Abstract

Keywords:
corticosteroidscourse of antibioticsinfluence factorsprotracted bacterial bronchitisstreptococcus pneumoniae

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