Cao Lu, Ji Zhaohua, Zhang Peng, Wang Jingwen
Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, China.
Department of Epidemiology and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an, China.
Front Pediatr. 2023 Mar 23;11:1031423. doi: 10.3389/fped.2023.1031423. eCollection 2023.
To identify the epidemiology and mortality predictors of severe childhood community-acquired pneumonia (CAP) and evaluate the influence of medications on clinical outcomes in the real world.
We conducted a multicenter retrospective observational study among children aged ≤5 years with severe CAP, separately comparing the detailed information between those who experienced in-hospital death and those who survived in three different age groups. A multivariate logistic regression model was used to determine mortality predictors.
A total of 945 children were recruited: 341 young children aged 2-59 months, 47 infants aged 29 days to 2 months, and 557 neonates aged less than 28 days. A total of 88 deaths occurred (9.3%). There was low adherence to antimicrobial guidelines in the group aged 2-59 months, and carbapenems widely served as initial empirical regimens. However, analysis of all three age groups showed that the efficacy of antibacterial drugs with initial empirical selection grades higher than those recommended by the guidelines was not better than that of antibacterial drugs with grades recommended by the guidelines. In multivariate analyses, very severe pneumonia (odds ratio (OR): 3.48; 95% confidence interval (CI): 1.36-8.93), lower birth weight (OR: 4.64; 95% CI: 1.78-12.20), severe underweight (OR: 6.06; 95% CI: 2.34-15.63), mechanical ventilation (OR: 2.58; 95% CI: 1.00-6.62; OR: 15.63; 95% CI 3.25-76.92), a higher number of comorbidities (OR: 8.40; 95% CI: 1.89-37.04), comorbidities including anemia (OR: 5.24; 95% CI: 2.33-11.76) and gastrointestinal hemorrhage (OR: 3.79; 95% CI: 1.36-10.53), and the use of sedative-hypnotics (OR: 2.60; 95% CI: 1.14-5.95) were independent risk factors for death; infants treated with probiotics had a lower mortality rate (OR: 0.14; 95% CI: 0.06-0.33).
Severe CAP remains a primary cause of death in children under 5 years of age. Clinical characteristics, comorbidities and medications are evidently associated with death. Importantly, we should pay particular attention to the identification of mortality predictors and establish prophylactic measures to reduce mortality.
确定儿童重症社区获得性肺炎（CAP）的流行病学特征及死亡预测因素，并评估药物治疗对实际临床结局的影响。
我们对年龄≤5岁的重症CAP患儿进行了一项多中心回顾性观察研究，分别比较了三个不同年龄组中院内死亡患儿与存活患儿的详细信息。采用多因素logistic回归模型确定死亡预测因素。
共纳入945例患儿：341例年龄为2 - 59个月的幼儿，47例年龄为29天至2个月的婴儿，557例年龄小于28天的新生儿。共发生88例死亡（9.3%）。2 - 59个月年龄组对抗菌药物指南的依从性较低，碳青霉烯类药物广泛用作初始经验性治疗方案。然而，对所有三个年龄组的分析表明，初始经验性选择等级高于指南推荐等级的抗菌药物的疗效并不优于指南推荐等级的抗菌药物。在多因素分析中，极重度肺炎（比值比（OR）：3.48；95%置信区间（CI）：1.36 - 8.93）、低出生体重（OR：4.64；95% CI：1.78 - 12.20）、重度低体重（OR：6.06；95% CI：2.34 - 15.63）、机械通气（OR：2.58；95% CI：1.00 - 6.62；OR：15.63；95% CI 3.25 - 76.92）、更多的合并症（OR：8.40；95% CI：1.89 - 37.04）、包括贫血（OR：5.24；95% CI：2.33 - 11.76）和胃肠道出血（OR：3.79；95% CI：1.36 - 10.53）在内的合并症以及使用镇静催眠药（OR：2.60；95% CI：1.14 - 5.95）是死亡的独立危险因素；接受益生菌治疗的婴儿死亡率较低（OR：0.14；95% CI：0.06 - 0.33）。
重症CAP仍然是5岁以下儿童死亡的主要原因。临床特征、合并症和药物治疗与死亡明显相关。重要的是，我们应特别关注死亡预测因素的识别，并建立预防措施以降低死亡率。
