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Aspiration pneumonia in children frequently involves anaerobic bacteria, similar to adults. Institutionalized children may also develop pneumonia due to aerobic or facultative bacteria, indicating nosocomial pathogens are involved.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Pulmonology
Background:
- Aspiration pneumonia in adults is predominantly caused by anaerobic bacteria.
- Previous studies on pediatric aspiration pneumonia bacteriology were limited by inadequate exclusion of oral flora and improper anaerobic culture techniques.
Purpose of the Study:
- To investigate the bacteriology of aspiration pneumonia in institutionalized children.
- To determine the role of anaerobic and aerobic/facultative bacteria in pediatric aspiration pneumonia.
Main Methods:
- Percutaneous transtracheal aspiration was used to collect samples from 74 institutionalized children with aspiration pneumonia.
- Bacterial cultures were performed to identify anaerobic and non-anaerobic (aerobic/facultative) organisms.
Main Results:
- An average of five bacteria were isolated per specimen, with 2.8 anaerobes and 2.2 nonanaerobes.
- Predominant anaerobic isolates included Gram-positive cocci, Bacteroides melaninogenicus, and fusobacteria.
- Common non-anaerobic isolates were alpha-hemolytic streptococci, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus.
Conclusions:
- Aspiration pneumonia in children commonly involves anaerobic bacteria, mirroring findings in adults.
- In institutionalized settings, nosocomial aerobic or facultative pathogens are also frequently implicated in pediatric aspiration pneumonia.
Abstract:
Aspiration pneumonia in adults has been shown to involve anaerobes about 90% of the time. Studies of the bacteriology of aspiration pneumonia in children done in the past have either failed to exclude the oral and upper respiratory tract flora or have not utilized proper anaerobic culture techniques or both. In the present study. 74 institutionalized children with aspiration pneumonia were studied by percutaneous transtracheal aspiration. Their average age was 8 years. Fifty-two patients had pneumonitis, 12, necrotizing pneumonia, and 10, lung abscess. Only one patient (with lung abscess) had a complicating empyema. There was an average of five bacteria isolated per specimen--2.8 anaerobes and 2.2 nonanaerobes. The predominant anaerobic isolates were Gram-positive cocci, Bacteroides melaninogenicus, and fuso-bacteria; there were ten patients who yielded members of the Bacteroides fragilis group. The predominant nonanaerobes were alpha-hemolytic streptococci, Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Thus, aspiration pneumonia in children, as in adults, commonly involves anaerobic bacteria. When aspiration occurs in a medical institution, nosocomial pathogens which are aerobic or facultative will also often be involved, in both children and adults.