Delport S D, Brisley T
Department of Paediatrics, Kalafong Hospital, University of Pretoria.
S Afr Med J. 2002 Nov;92(11):907-11.
To determine the aetiological agents and outcome of severe community-acquired pneumonia (SCAP) in children admitted to the paediatric intensive care unit (PICU) at Kalafong Hospital, Pretoria.
An audit was done after a protocol was implemented to identify the aetiological agents in children with life-threatening SCAP admitted to the PICU from the emergency room. The following investigations were done as per protocol: blood culture, culture of the tracheal aspirate, immunofluorescence and culture of the nasopharyngeal aspirate, microscopy and culture of the gastric juice for Mycobacterium tuberculosis, and determination of HIV status. The following data, documented prospectively, were obtained from patient records: date of admission, age, gender, weight, duration of ventilation, duration of stay in the PICU, survival or death, and severity of illness as determined by means of the score for acute neonatal physiology (SNAP) or paediatric risk of mortality (PRISM) score depending on the child's age.
Twenty-three children were admitted over a 1-year period (1 November 1994-30 October 1995). Their median age was 10 weeks (range 2 weeks-5 years) and the sex distribution was equal. Two children were HIV-infected. Twenty children received mechanical ventilation for a median period of 6.5 days (range 2-16 days). Aetiological agents were identified in 15/23 children (65%). Respiratory syncytial virus (RSV) was the most common pathogen, identified in 7/23 children, Klebsiella pneumoniae was the most common bacterial pathogen, identified in 5 children (2 blood cultures and 3 tracheal aspirates). Tuberculosis was not diagnosed. The mean PRISM score was similar in survivors and children who died. The case fatality rate was 30%. The 7 children who died had a median arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2) ratio of 94 (range 32-111) and the 16 survivors had a median ratio of 146 (range 51-252) (P = 0.01) on admission. Both HIV-infected children died and postmortem examination showed a pneumonia due to Pneumocystis carinii and cytomegalovirus.
SCAP occurs in very young children. One or more pathogens were isolated in 65% of cases. Viral pathogens predominated, with RSV being the most common. The yield of positive blood cultures was low at 17%. Streptococcus pneumoniae and Haemophilus influenzae were not found. The case fatality rate was 30% and death was more likely with a low PaO2/FiO2 ratio on admission.
确定比勒陀利亚卡拉方医院儿科重症监护病房（PICU）收治的儿童重症社区获得性肺炎（SCAP）的病原体及转归情况。
在实施一项方案后进行审计，以确定从急诊室收治入PICU的危及生命的SCAP患儿的病原体。按方案进行了以下检查：血培养、气管吸出物培养、免疫荧光及鼻咽吸出物培养、胃液结核分枝杆菌镜检及培养，以及HIV状态测定。从患者记录中前瞻性收集以下数据：入院日期、年龄、性别、体重、通气时间、在PICU的住院时间、存活或死亡情况，以及根据患儿年龄通过急性新生儿生理学评分（SNAP）或儿科死亡风险（PRISM）评分确定的疾病严重程度。
在1年期间（1994年11月1日至1995年10月31日）共收治23例患儿。他们的中位年龄为10周（范围2周 - 5岁），性别分布均衡。2例患儿感染HIV。20例患儿接受机械通气，中位时间为6.5天（范围2 - 16天）。23例患儿中有15例（65%）确定了病原体。呼吸道合胞病毒（RSV）是最常见的病原体，在23例患儿中有7例检出；肺炎克雷伯菌是最常见的细菌病原体，5例患儿中检出（2例血培养及3例气管吸出物培养）。未诊断出结核病。存活患儿和死亡患儿的平均PRISM评分相似。病死率为30%。7例死亡患儿入院时动脉血氧分压/吸入氧分数（PaO2/FiO2）比值的中位数为94（范围32 - 111），16例存活患儿该比值的中位数为146（范围51 - 252）（P = 0.01）。2例感染HIV的患儿均死亡，尸检显示为卡氏肺孢子虫和巨细胞病毒所致肺炎。
SCAP发生于幼儿。65%的病例分离出一种或多种病原体。病毒病原体占主导，RSV最为常见。血培养阳性率低，为17%。未发现肺炎链球菌和流感嗜血杆菌。病死率为30%，入院时PaO2/FiO2比值低者死亡可能性更大。
