Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia.
Da Nang Hospital for Women and Children, Vietnam.
Clin Infect Dis. 2020 Apr 10;70(8):1733-1741. doi: 10.1093/cid/ciz445.
Pneumonia is the leading cause of antibiotic use and hospitalization in Vietnam. There is a need for better prediction of unlikely bacterial pneumonia and adverse pneumonia outcome in order to guide hospital admission and improve rational antibiotic use.
All children under 5 admitted with pneumonia (per clinician assessment) to the Da Nang Hospital for Women and Children were prospectively enrolled. Children were classified as having likely or unlikely bacterial pneumonia and followed for outcome assessment. A Bayesian model averaging approach was used to identify predictors of unlikely bacterial pneumonia and adverse pneumonia outcome, which guided the development of a pragmatic management algorithm.
Of 3817 patients assessed, 2199 (57.6%) met World Health Organization (WHO) pneumonia criteria. In total, 1594 (41.7%) children were classified as having unlikely and 129 (3.4%) as having likely bacterial pneumonia. The remainder (2399; 62.9%) were considered to have disease of uncertain etiology. Factors predictive of unlikely bacterial pneumonia were no fever, no consolidation on chest radiograph, and absolute neutrophil count <5 × 109/L at presentation, which had a negative predictive value (NPV) for likely bacterial pneumonia of 99.0%. Among those who met WHO pneumonia criteria, 8.6% (189/2199) experienced an adverse outcome. Not having any WHO danger sign or consolidation on chest radiograph had an NPV of 96.8% for adverse pneumonia outcome.
An algorithm that screens for predictors of likely bacterial pneumonia and adverse pneumonia outcome could reduce unnecessary antibiotic use and hospital admission, but its clinical utility requires validation in a prospective study.
肺炎是越南导致抗生素使用和住院的主要原因。需要更好地预测不太可能发生细菌肺炎和不良肺炎结局，以指导住院和改善合理使用抗生素。
所有因肺炎（根据临床医生评估）入住岘港妇女儿童医院的 5 岁以下儿童均前瞻性入组。将儿童分为可能或不太可能发生细菌性肺炎，并对其结局进行评估。采用贝叶斯模型平均方法来确定不太可能发生细菌性肺炎和不良肺炎结局的预测因素，从而指导实用管理算法的制定。
在评估的 3817 例患者中，2199 例（57.6%）符合世界卫生组织（WHO）肺炎标准。共有 1594 例（41.7%）儿童被归类为不太可能发生细菌性肺炎，129 例（3.4%）被归类为可能发生细菌性肺炎。其余 2399 例（62.9%）被认为病因不明。不太可能发生细菌性肺炎的预测因素为无发热、胸部 X 线片无实变和中性粒细胞绝对计数＜5×109/L，这些因素对可能发生细菌性肺炎的阴性预测值为 99.0%。在符合 WHO 肺炎标准的患者中，8.6%（189/2199）出现不良结局。无任何 WHO 危险征象或胸部 X 线片无实变的患者，不良肺炎结局的阴性预测值为 96.8%。
一种用于筛选可能发生细菌性肺炎和不良肺炎结局的预测因素的算法可以减少不必要的抗生素使用和住院，但需要前瞻性研究验证其临床实用性。
