The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children

Abstract

Community-acquired pneumonia (CAP) severely affects pediatric hospitalizations. This study assessed the contribution of CAP to hospitalizations, its etiology in relationship with age, and the inflammatory markers. Between 2013 and 2018, 1064 CAP patients were hospitalized and diagnosed with bacterial/possibly bacterial pneumonia (BP), viral/possibly viral pneumonia (VP) and atypical pneumonia (AP). The etiology was confirmed using blood/pleural fluid culture/polymerase chain reaction (PCR), rapid antigen test/PCR in nasopharyngeal swabs, or serological studies. CAP accounted for 9.9% of hospitalizations and 14.8% of patient days. BP was diagnosed in 825 (77.5%), VP in 190 (17.9%), and AP in 49 (4.6%) cases; the confirmed etiology (n = 209; 20%) included mostly influenza (39%; n = 82), respiratory syncytial virus (RSV, 35%; n = 72), and Mycoplasma pneumoniae (19%; n = 39). VP frequency decreased with age (41% in < 3 mo to 9% in ≥ 60 mo), in contrast to AP (13% in ≥ 60 mo). Among the analyzed parameters, the best differentiating potential was shown by: C-reactive protein (CRP, AUCBP-VP = 0.675; 95% CI: 0.634–0.715), procalcitonin (AUCBP-AP = 0.73; 95% CI: 0.67–0.794), and CRP/procalcitonin (AUCAP-VP = 0.752; 95% CI: 0.67–0.83); a good positive predictive value (88.8%, 98.3%, and 91.6%, respectively) but a low negative predictive value (29.5%, 13.1%, and 40.7%, respectively) was observed. CAP influences hospital patient days more than the crude number of patients would suggest. On a clinical basis, BP is mainly recognized, although viral pneumonia is confirmed most often. RSV and influenza are responsible for a huge percentage of hospitalized cases, as well as M. pneumoniae in children aged ≥ 5 years. Serum inflammatory markers may help differentiate etiological factors.

Procalcitonin and Presepsin as Markers of Infectious Respiratory Diseases in Children: A Scoping Review of the Literature

“…We did not find any studies that evaluated presepsin levels in children with RTIs. The full list of studies included in this scoping review is detailed in tables, and the Excel form for all details assessed for each study is available upon request to the corresponding authors [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

Dynamics of platelet parameters in children with severe community-acquired pneumonia between viral and bacterial infections

“…Several studies have shown that blood inflammatory biomarkers, such as procalcitonin and CRP, can assist in differentiating between bacterial and viral CAP ( 28 , 29 ). In recent years, platelets have been found to detect endothelial cell damage and pathogenic microorganism invasion, forming the first line of defense against pathogenic infections ( 30 ).…”

Community-acquired bacterial pneumonia in children: an update on antibiotic duration and immunization strategies

“…Many approaches to differentiate viral and bacterial CAP have been studied without definitive conclusions (consolidation on chest radiograph, inflammatory markers, induced sputum, etc.) [4][5][6]. Viruses (>70%) are by far the most common identified pathogen in hospitalized children with CAP, followed by Mycoplasma pneumoniae (8%) and Streptococcus pneumoniae (4%) [7].…”