Comparison of the frequency of bacterial and viral infections among children with community-acquired pneumonia hospitalized across distinct severity categories: a prospective cross-sectional study

Abstract

BackgroundThe comparison of the frequencies of bacterial and viral infections among children with community-acquired pneumonia (CAP) admitted in distinct severity categories, in an original study, is lacking in literature to-date. We aimed to achieve this goal.MethodsChildren aged 2-59-months-old hospitalized with CAP were included in this prospective study in Salvador, Brazil. Clinical data and biological samples were collected to investigate 11 viruses and 8 bacteria. Severity was assessed by using the World Health Organization criteria.ResultsOne hundred eighty-one patients were classified as “non-severe” (n = 53; 29.3 %), “severe” (n = 111; 61.3 %), or “very severe” (n = 17; 9.4 %) CAP. Overall, aetiology was detected among 156 (86.2 %) cases; viral (n = 84; 46.4 %), bacterial (n = 26; 14.4 %) and viral-bacterial (n = 46; 25.4 %) infections were identified. Viral infection frequency was similar in severe/very severe and non-severe cases (46.1 % vs. 47.2 %; p = 0.9). Pneumococcal infection increased across “non-severe” (13.2 %), “severe” (23.4 %), and “very severe” (35.3 %) cases (qui-squared test for trend p = 0.04). Among patients with detected aetiology, after excluding cases with co-infection, the frequency of sole bacterial infection was different (p = 0.04) among the categories; non-severe (12.5 %), severe (29.3 %) or very severe (55.6 %). Among these patients, sole bacterial infection was independently associated with severity (OR = 4.4 [95 % CI:1.1–17.6]; p = 0.04) in a model controlled for age (OR = 0.7 [95 % CI:0.5–1.1]; p = 0.1).ConclusionsA substantial proportion of cases in distinct severity subgroups had respiratory viral infections, which did not differ between severity categories. Bacterial infection, particularly pneumococcal infection, was more likely among severe/very severe cases.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0645-3) contains supplementary material, which is available to authorized users.

Etiology and Impact of Coinfections in Children Hospitalized With Community-Acquired Pneumonia

“…Whether some viruses such as hRV could cause severe acute respiratory illness in the absence of a coinfection has been questioned [19]. We observed severe disease at a low frequency with both single hRV infections and coinfections where hRV was detected, but we did not observe a difference between these groups, as others have reported [18]. In general, virus-virus coinfections were not more severe than single-virus infections and did not have worse outcomes (Tables 2 and 3), in agreement with a smaller study [20].…”

“…In influenza studies, bacterial coinfection is common in severe and fatal cases [7,11,16]. In particular, the presence of S. pneumoniae and S. aureus is associated with high morbidity and mortality [7,8,17,18]. Similarly, while very few deaths were observed during this study, serious outcomes occurred more frequently in children with virus-bacterium coinfections as compared to those virus infections, and their length of hospital stay was longer.…”

High incidence of rhinovirus infection in children with community‐acquired pneumonia from a city in the Brazilian pre‐Amazon region

“…Other studies also identified rhinovirus among most frequent viruses identified in patients with ARIs, including CAP . For example, Nascimento‐Carvalho et al investigated multiple respiratory viruses in 181 children with CAP from Salvador in northeastern Brazil, detecting rhinovirus most frequently. However, despite its high prevalence, few others have tested for this pathogen .…”

An approach to the child with a wet cough

“…[23] When a diagnosis of CAP is made the child should receive a course of antibiotics as bacterial and viral pneumonia cannot reliably be distinguished from each other. [24] Oral amoxicillin is the first line antibiotic. [18] Intravenous antibiotics are only necessary in uncomplicated CAP if the child is unable to take or absorb oral antibiotics (eg vomiting).…”