A cross-sectional study of the clinical characteristics of hospitalized children with community-acquired pneumonia in eight eastern cities in China

Abstract

BackgroundCommunity-acquired pneumonia in children is common in China. To understand current clinical characteristics and practice, we conducted a cross-sectional study to analyze quality of care on childhood pneumonia in eight eastern cities in China.MethodsConsecutive hospital records between January 1, 2010 and December 31, 2010 were collected from 13 traditional Chinese medicine (TCM) and western medicine (WM) hospitals in February, May, August, and November (25 cases per season, 100 cases over the year), respectively. A predesigned case report form was used to extract data from the hospital medical records.ResultsA total of 1298 cases were collected and analyzed. Symptoms and signs upon admission at TCM and WM hospitals were cough (99.3% vs. 98.6%), rales (84.8% vs. 75.0%), phlegm (83.3% vs. 49.1%), and fever (74.9% vs. 84.0%) in frequency. Patients admitted to WM hospitals had symptoms and signs for a longer period prior to admission than patients admitted to TCM hospitals. Testing to identify etiologic agents was performed in 1140 cases (88.4%). Intravenous antibiotics were administered in 99.3% (595/598) of cases in TCM hospitals and in 98.6% (699/700) of cases in WM hospitals. Besides, Chinese herbal extract injection was used more frequently in TCM hospitals (491 cases, 82.1%) than in WM hospitals (212 cases, 30.3%) (p < 0.01). At discharge, 818 cases (63.0%) were clinically cured, with a significant difference between the cure rates in TCM (87.6%) and WM hospitals (42.0%) (OR = 9.8, 95% confidence interval (CI): 7.3 ~ 12.9, p < 0.01). Pathogen and previous medical history were more likely associated with the disappearance of rales (OR = 7.2, 95% CI: 4.8 ~ 10.9). Adverse effects were not reported from the medical records.ConclusionsIntravenous use of antibiotics is highly prevalent in children with community-acquired pneumonia regardless of aetiology. There was difference between TCM and WM hospitals with regard to symptom profile and the use of antibiotics. Intravenous use of herbal injection was higher in TCM hospitals than in WM hospitals. Most of the cases were diagnosed based on clinical signs and symptoms without sufficient confirmation of aetiology. Audit of current practice is urgently needed to improve care.

A Study of the Clinical Characteristics of Hospitalized Pneumonia Patients in Alexandria University Children's Hospital

“…Cough was the most common presenting symptom in the present study, as it occurred in 99.2% of patients, while fever occurred in 87.7% of patients. It was also found that wheezes was present in 75.4% of the studied cases, which is similar to what was reported by Wang et al and Al-Dabbagh et al (11,14) . This is may be due to mixed viral/bacterial pneumonia or associated bronchial asthma, and the fact that most of the cases in both studies were infants who are prone to wheezes because of small caliber peripheral airways.…”

“…The current study found that male to female ratio of pneumonia cases was 1:1, which is lower than reported by Wang et al 2013 (11) ,which was 1.4: 1.Lifestyle, behavioral, and socioeconomic differences between males and females may explain the observed findings.…”

The etiology of community-acquired pneumonia among children under 5 years of age in mainland China, 2001–2015: A systematic review

“…In many children with CAP, more than 2 pathogens may be identified in diagnostic testing, including viral and bacterial combinations, which makes it difficult to determine the significance of any single pathogen. 55,72 2) There were constraints in determining etiologies based on available methods. Most bacterial pathogens were isolated from NA and sputum cultures; this could represent colonization rather than infection.…”

Serotype Distribution, Antimicrobial Susceptibility, and Molecular Epidemiology of Streptococcus pneumoniae Isolated from Children in Shanghai, China

“…This phenomenon may be the result of the widespread use of third-generation cephalosporins. A cross-sectional study conducted in 2013 showed that the antibiotics commonly used by decreasing frequency were macrolides, third generation cephalosporins, second-generation cephalosporins, first generation cephalosporins, and β-lactams in Chinese hospitals [ 20 ]. In fact, the situation of inappropriate use and abuse of cephalosporins has been reported in China [ 21 – 22 ].…”