Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
J Glob Health. 2022 Jul 23;12:10009. doi: 10.7189/jogh.12.10009.
This systematic review aimed to describe common aetiologies of severe and non-severe community acquired pneumonia among children aged 1 month to 9 years in low- and middle-income countries.
We searched the MEDLINE, EMBASE, and PubMed online databases for studies published from January 2010 to August 30, 2020. We included studies on acute community-acquired pneumonia or acute lower respiratory tract infection with ≥1 year of continuous data collection; clear consistent case definition for pneumonia; >1 specimen type (except empyema studies where only pleural fluid was required); testing for >1 pathogen including both viruses and bacteria. Two researchers reviewed the studies independently. Results were presented as a narrative summary. Quality of evidence was assessed with the Quality Assessment Tool for Quantitative Studies. The study was registered on PROSPERO [CRD42020206830].
We screened 5184 records; 1305 duplicates were removed. The remaining 3879 titles and abstracts were screened. Of these, 557 articles were identified for full-text review, and 55 met the inclusion criteria - 10 case-control studies, three post-mortem studies, 11 surveillance studies, eight cohort studies, five cross-sectional studies, 12 studies with another design and six studies that included patients with pleural effusions or empyema. Studies which described disease by severity showed higher bacterial detection (Streptococcus pneumoniae, Staphylococcus aureus) in severe vs non-severe cases. The most common virus causing severe disease was respiratory syncytial virus (RSV). Pathogens varied by age, with RSV and adenovirus more common in younger children. Influenza and atypical bacteria were more common in children 5-14 years than younger children. Malnourished and HIV-infected children had higher rates of pneumonia due to bacteria or tuberculosis.
Several viral and bacterial pathogens were identified as important targets for prevention and treatment. Bacterial pathogens remain an important cause of moderate to severe disease, particularly in children with comorbidities despite widespread PCV and Hib vaccination.
本系统评价旨在描述 1 个月至 9 岁儿童中在低收入和中等收入国家中社区获得性肺炎重症和非重症的常见病因。
我们检索了 MEDLINE、EMBASE 和 PubMed 在线数据库，以获取 2010 年 1 月至 2020 年 8 月 30 日发表的研究。我们纳入了关于急性社区获得性肺炎或急性下呼吸道感染的研究，这些研究有至少 1 年的连续数据收集；有明确一致的肺炎病例定义；有超过 1 种标本类型（仅需胸腔积液的脓胸研究除外）；有针对包括病毒和细菌在内的多种病原体的检测。两名研究人员独立审查了这些研究。结果以叙述性综述呈现。使用定量研究质量评估工具评估证据质量。该研究在 PROSPERO 上进行了注册[CRD42020206830]。
我们筛选了 5184 条记录；排除了 1305 条重复记录。剩余 3879 条标题和摘要进行了筛选。其中，有 557 篇文章被确定为全文审查，有 55 篇符合纳入标准-10 篇病例对照研究、3 篇尸检研究、11 项监测研究、8 项队列研究、5 项横断面研究、12 项其他设计研究和 6 项包括胸腔积液或脓胸患者的研究。描述疾病严重程度的研究显示，重症病例的细菌检出率（肺炎链球菌、金黄色葡萄球菌）较高。导致重症疾病的最常见病毒是呼吸道合胞病毒（RSV）。病原体因年龄而异，RSV 和腺病毒在年幼儿童中更为常见。流感和非典型细菌在 5-14 岁儿童中比年幼儿童更为常见。营养不良和 HIV 感染的儿童因细菌或结核病导致肺炎的发生率更高。
已确定几种病毒和细菌病原体是预防和治疗的重要目标。尽管广泛使用 PCV 和 Hib 疫苗接种，但细菌病原体仍然是中重度疾病的重要原因，尤其是在合并症儿童中。
