Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
BMJ Open. 2019 Mar 30;9(3):e026895. doi: 10.1136/bmjopen-2018-026895.
Pneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children.
A 9-year case series study.
Two secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines.
5054 children aged <5 years hospitalised with severe pneumonia.
Nasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death.
Of the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2-59 months, the risk factors significantly associated with death included age of 2-5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months.
Malnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.
肺炎仍然是 5 岁以下儿童住院和死亡的主要原因。多种呼吸道病原体可引起急性呼吸道感染，包括肺炎。在此，我们分析了与住院儿童死亡相关的病毒和细菌病原体及危险因素。
一项为期 9 年的病例系列研究。
菲律宾的两家二级保健医院、一家三级保健医院和一家研究中心。
5054 名 5 岁以下因重症肺炎住院的儿童。
采集鼻咽拭子进行病毒鉴定，采集静脉血样进行细菌培养。在入院时收集人口统计学、临床数据和实验室结果。采用 logistic 回归分析确定与死亡相关的因素。
在纳入的患者中，57%（2876/5054）为男性。病死率为 4.7%（238/5054），研究期间呈下降趋势（p<0.001）。55.0%死亡的患者体重不足或严重不足。61.0%的患者检测到病毒，其中呼吸道合胞病毒（27.0%）和鼻病毒（23.0%）是最常见的病毒。在 2-59 月龄的儿童中，与死亡显著相关的危险因素包括 2-5 月龄、感觉改变、严重营养不良、呼噜声、中心性发绀、呼吸音减弱、呼吸急促、发热（≥38.5°C）、外周血氧饱和度<90%、浸润、实变和胸腔积液。在病原体中，腺病毒 7 型、季节性流感 A（H1N1）和血培养阳性细菌与死亡显著相关。在<2 月龄的死亡病例中也观察到了类似的模式与上述因素之间的关系。
营养不良是与死亡最相关的常见因素，解决这个问题可能会降低病死率。此外，应在所有住院肺炎患者中推广进行胸部 X 线检查和血氧饱和度测量，以及细菌检测，以识别有死亡风险的患者。
