Department of Pediatrics and Child Health, Bugando Medical Centre, Mwanza, Tanzania.
Department of Pediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania.
PLoS One. 2020 Dec 11;15(12):e0243636. doi: 10.1371/journal.pone.0243636. eCollection 2020.
Despite recent advances in management and preventive strategies, high rates of first line antibiotics treatment failure and case fatality for Severe Community Acquired Pneumonia (SCAP) continue to occur in children in low and middle-income countries. This study aimed to identify the predictors and outcome of first line antibiotics treatment failure among children under-five years of age with SCAP admitted at Bugando Medical Centre (BMC) in Mwanza, Tanzania.
The study involved under-five children admitted with SCAP, treated with first line antibiotics as recommended by WHO. Patients with treatment failure at 48 hours were shifted to second line of antibiotics treatment and followed up for 7 days. Generalized linear model was used to determine predictors of first line antibiotics treatment failure for SCAP.
A total of 250 children with SCAP with a median age of 18 [IQR 9-36] months were enrolled, 8.4% had HIV infection and 28% had acute malnutrition. The percentage of first line antibiotics treatment failure for the children with SCAP was 50.4%. Predictors of first line treatment failure were; presentation with convulsion (RR 1.55; 95% CI [1.11-2.16]; p-value 0.009), central cyanosis (RR 1.55; 95% CI [1.16-2.07]; p-value 0.003), low oxygen saturation (RR 1.28; 95% CI [1.01-1.62]; p-value 0.04), abnormal chest X-ray (RR 1.71; 95% CI [1.28-2.29]; p-value <0.001), HIV infection (RR 1.80; 95% CI [1.42-2.27]; p-value 0.001), moderate acute malnutrition (RR 1.48; 95% CI [1.04-2.12]; p-value = 0.030) and severe acute malnutrition (RR 2.02; 95% CI [1.56-2.61]; p-value<0.001). Mortality in children who failed first line treatment was 4.8%.
Half of the children with SCAP at this tertiary center had first line antibiotics treatment failure. HIV infection, acute malnutrition, low oxygen saturation, convulsions, central cyanosis, and abnormal chest X-ray were independently predictive of first line treatment failure. We recommend consideration of second line treatment and clinical trials for patients with SCAP to reduce associated morbidity and mortality.
尽管在管理和预防策略方面取得了最近的进展，但在中低收入国家，儿童严重社区获得性肺炎（SCAP）的一线抗生素治疗失败率和病死率仍然很高。本研究旨在确定在坦桑尼亚姆万扎布甘多医学中心（BMC）住院的五岁以下患有 SCAP 的儿童中，一线抗生素治疗失败的预测因素和结果。
本研究纳入了符合 SCAP 标准并接受世卫组织推荐的一线抗生素治疗的五岁以下儿童。48 小时治疗失败的患者将转为二线抗生素治疗，并随访 7 天。采用广义线性模型确定 SCAP 一线抗生素治疗失败的预测因素。
共纳入 250 名患有 SCAP 的五岁以下儿童，中位年龄为 18 [IQR 9-36] 个月，8.4%的儿童感染了艾滋病毒，28%的儿童患有急性营养不良。患有 SCAP 的儿童中，一线抗生素治疗失败的比例为 50.4%。一线治疗失败的预测因素包括：惊厥发作（RR 1.55；95%CI [1.11-2.16]；p 值=0.009）、中央发绀（RR 1.55；95%CI [1.16-2.07]；p 值=0.003）、低血氧饱和度（RR 1.28；95%CI [1.01-1.62]；p 值=0.04）、异常胸部 X 线（RR 1.71；95%CI [1.28-2.29]；p 值<0.001）、HIV 感染（RR 1.80；95%CI [1.42-2.27]；p 值=0.001）、中度急性营养不良（RR 1.48；95%CI [1.04-2.12]；p 值=0.030）和严重急性营养不良（RR 2.02；95%CI [1.56-2.61]；p 值<0.001）。一线治疗失败儿童的死亡率为 4.8%。
在这个三级中心，一半的 SCAP 患儿存在一线抗生素治疗失败。HIV 感染、急性营养不良、低血氧饱和度、惊厥发作、中央发绀和异常胸部 X 线是一线治疗失败的独立预测因素。我们建议考虑对 SCAP 患者进行二线治疗和临床试验，以降低相关发病率和死亡率。
