Enrique Otheo1, Mario Rodríguez2,3, Cinta Moraleda4,5,6,7, Sara Domínguez-Rodríguez4,5,7, María D Martín8, María L Herreros9, Carmen Vázquez1, María D Folgueira10, Alfredo Pérez-Rivilla10, Julia Jensen11, Agustín López12, Arantxa Berzosa13, Francisco J Sanz de Santaeufemia14, Ana B Jiménez15, Talía Sainz5,16, Marta Llorente17, Mar Santos5,18, Elisa Garrote19, Cristina Muñoz20, Paula Sánchez21, Marta Illán22, Ana Coca23, Ana Barrios9, Mónica Pacheco9, Carmen Arquero9, Lourdes Gutiérrez4,5,7, Cristina Epalza4,5,6,7, Pablo Rojo4,5,6,7,24, Miquel Serna-Pascual4,5,7, Inmaculada Mota25, Santiago Moreno26, Juan C Galán2,3, Alfredo Tagarro4,5,7,9,27. 1. Department of Pediatrics, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. 2. Department of Microbiology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal para la Investigación Sanitaria (IRYCIS), Madrid, Spain. 3. Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 4. Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Madrid, Spain. 5. RITIP (Translational Research Network in Pediatric Infectious Diseases), Madrid, Spain. 6. Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Madrid, Spain. 7. Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain. 8. Department of Microbiology, Laboratorio BR Salud, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain. 9. Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain. 10. Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain. 11. Department of Pediatrics, Hospital Infanta Cristina , Parla, Madrid, Spain. 12. Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. 13. Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain. 14. Department of Pediatrics, Hospital Universitario Niño Jesús, Madrid, Spain. 15. Department of Pediatrics, Fundación Jiménez Díaz, Madrid, Spain. 16. Department of Pediatrics, Infectious and Tropical Diseases, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPAZ), Madrid, Spain. 17. Department of Pediatrics, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain. 18. Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid, Spain. 19. Department of Pediatrics, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain. 20. Department of Pediatrics, Hospital General de Villalba, Villalba, Madrid, Spain. 21. Pediatric Infectious Diseases, Immunology and Rheumatology Unit, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain. 22. Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain. 23. Pediatric Intensive Care Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain. 24. Department of Pediatrics, Universidad Complutense de Madrid, Madrid, Spain. 25. Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 26. Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. 27. Pediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain.
Abstract
OBJECTIVES: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN: Observational, multicenter, and prospective study. PATIENT SELECTION: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.
OBJECTIVES: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN: Observational, multicenter, and prospective study. PATIENT SELECTION: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.
Authors: Javier de-Miguel-Díez; Ana López-de-Andrés; Valentín Hernández-Barrera; José M de-Miguel-Yanes; David Carabantes-Alarcón; Zichen Ji; Jose J Zamorano-Leon; Rodrigo Jiménez-García Journal: Eur J Pediatr Date: 2022-04-25 Impact factor: 3.860
Authors: Rut Del Valle; Álvaro Ballesteros; Cristina Calvo; Talía Sainz; Ana Mendez; Carlos Grasa; Paula R Molina; María J Mellado; Francisco J Sanz-Santaeufemia; Blanca Herrero; Lourdes Calleja; Antoni Soriano-Arandes; Susana Melendo; Elena Rincón-López; Alicia Hernánz; Cristina Epalza; Carmen García-Baeza; E Rupérez-García; Arantxa Berzosa; Angustias Ocaña; Alvaro Villarroya-Villalba; Ana Barrios; Enrique Otheo; Juan C Galán; Mario José Rodríguez; Juan M Mesa; Sara Domínguez-Rodríguez; Cinta Moraleda; Alfredo Tagarro Journal: Pediatr Pulmonol Date: 2022-07-08