Berg Are Stuwitz, Inchley Christopher Stephen, Aase Audun, Fjaerli Hans Olav, Bull Reidun, Aaberge Ingeborg, Leegaard Truls Michael, Nakstad Britt
From the *Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; †Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway; ‡Department of Radiology and §Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway; and ¶Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Pediatr Infect Dis J. 2016 Mar;35(3):e69-75. doi: 10.1097/INF.0000000000001009.
Improved Childhood Immunizations Programs, especially the introduction of pneumococcal vaccination, better diagnostic methods and the importance of reduced antibiotic misuse, make this a critical time to increase knowledge on the etiology of pediatric pneumonia. Our main objective was to identify the contribution of various microbiological species that causes pneumonia in previously healthy children and adolescents in a population with high pneumococcal conjugate vaccine coverage.
This prospective, observational study enrolled patients with clinical and radiological signs of pneumonia over a 2-year period. Both inpatients and outpatients were included. Paired sera, nasopharyngeal polymerase chain reaction and bacterial cultures from blood and pleura were analyzed to detect potential viral and bacterial causative pathogens.
TWO HUNDRED AND SIXTY-FIVE: cases of clinical and radiological verified pneumonia were identified. The pneumococcal vaccine coverage was 85%. We identified a causative pathogen in 84.2% of all cases; 63.4% with single viral etiology, 11.3% with pneumococcus and 7.5% with mycoplasma infection. Respiratory syncytial virus was the most common pathogen in children younger than 5 years, whereas mycoplasma was the most common in older children.
We identified the majority of 265 cases with radiology proven pneumonia as single viral infections, predominantly respiratory syncytial virus and a much lower proportion of bacterial causes. These findings may impact pneumonia management guidelines in areas where widespread pneumococcal vaccination is provided and contribute to reduced antibiotic overuse in pediatric pneumonia.
改进的儿童免疫规划，特别是肺炎球菌疫苗的引入、更好的诊断方法以及减少抗生素滥用的重要性，使得现在成为增加对儿童肺炎病因认识的关键时期。我们的主要目标是确定在肺炎球菌结合疫苗高覆盖率人群中，导致先前健康的儿童和青少年肺炎的各种微生物种类的作用。
这项前瞻性观察性研究在两年期间纳入了有肺炎临床和放射学体征的患者。住院患者和门诊患者均包括在内。对配对血清、鼻咽聚合酶链反应以及血液和胸膜的细菌培养物进行分析，以检测潜在的病毒和细菌致病病原体。
共确定了265例临床和放射学确诊的肺炎病例。肺炎球菌疫苗覆盖率为85%。我们在所有病例的84.2%中确定了致病病原体；63.4%为单一病毒病因，11.3%为肺炎球菌，7.5%为支原体感染。呼吸道合胞病毒是5岁以下儿童最常见的病原体，而支原体在大龄儿童中最常见。
我们将265例经放射学证实的肺炎病例中的大多数确定为单一病毒感染，主要是呼吸道合胞病毒，细菌病因的比例要低得多。这些发现可能会影响在广泛接种肺炎球菌疫苗地区的肺炎管理指南，并有助于减少儿童肺炎中抗生素的过度使用。
