Analysis of national surveillance of respiratory pathogens for community-acquired pneumonia in children and adolescents

Abstract

Background Respiratory infections among children, particularly community-acquired pneumonia (CAP), is a major disease with a high frequency among outpatient and inpatient visits. The causes of CAP vary depending on individual susceptibility, the epidemiological characteristics of the community, and the season. We performed this study to establish a nationwide surveillance network system and identify the causative agents for CAP and antibiotic resistance in Korean children with CAP. Methods The monitoring network was composed of 28 secondary and tertiary medical institutions. Upper and lower respiratory samples were assayed using a culture or polymerase chain reaction (PCR) from August 2018 to May 2020. Results A total of 1023 cases were registered in patients with CAP, and PCR of atypical pneumonia pathogens revealed 422 cases of M. pneumoniae (41.3%). Respiratory viruses showed a positivity rate of 65.7% by multiplex PCR test, and human rhinovirus was the most common virus, with 312 cases (30.5%). Two hundred sixty four cases (25.8%) were isolated by culture, including 131 cases of S. aureus (12.8%), 92 cases of S. pneumoniae (9%), and 20 cases of H. influenzae (2%). The cultured, isolated bacteria may be colonized pathogen. The proportion of co-detection was 49.2%. The rate of antibiotic resistance showed similar results as previous reports. Conclusions This study will identify the pathogens that cause respiratory infections and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infections. Additionally, in preparation for new epidemics, including COVID-19, monitoring respiratory infections in children and adolescents has become more important, and research on this topic should be continuously conducted in the future.

Nasopharyngeal aspirates in children with severe community-acquired pneumonia collected within 3 days before bronchoscopy can partially reflect the pathogens in bronchoalveolar lavage fluids

“…Possible reasons for that discrepancy include: 1)Prior to the collection of BALFs, use of antibiotics possibly led to negative HI detection in BALFs. 2)HI had different meanings in the upper and lower respiratory tracts in those patients, or caused inflammation in different parts of the airway in the same case [ 29 , 30 ]. As the length of the hospital stay increased, patient community-acquired Gram positive flora are increasingly replaced by hospital-acquired Gram negative flora, and the risk of hospital acquired pneumonia increases.…”

“…Second, we did not use more sensitive molecular biological diagnostic methods, which might lead to low detention rates of pathogens [ 18 , 31 , 32 ]. Third, the human rhinovirus (HRV) was not studied which has become identified as a more prominent lower airway pathogen than previously suspected [ 5 , 7 , 9 , 16 , 17 , 19 , 21 , 28 , 30 ]. We still believed that our study had unique significances, given that the DFA method was based on the existent of viruses antigens judged by naked eyes with fluorescence microscope, and the routine bacterial culture, which are the two classical methods for pathogens detection.…”

Epidemiology and surveillance implications of community-acquired pneumonia in children

“…This study showed the antibiotic-resistance rate of bacterial pathogens; among a total of 93 cases of S. pneumoniae, 14.1% were resistant to penicillin, 8.7% to cefotaxime, 93.5% to erythromycin, 79.3% to tetracycline, and 1.1% to levofloxacin. 66) As mentioned earlier, the identification of bacteria from the upper respiratory tract does not always determine the causative pathogen of CAP. However, bacterial-virus coinfections may be the causative agents of pneumonia after viral infection.…”

“…We recently reported a nationwide study of the causative pathogen of CAP in Korean children and adolescents. 66) The study was performed at a cooperative hospital monitoring network composed of secondary and tertiary hospitals in six metropolitan areas (Seoul, Gyeonggi Province, Chungcheong Province, Gangwon Province, Jeolla Province, Gyeongsang…”

“…pneumoniae in 3.7%. 66) It is also known that the rate of co-infection is higher in severe M. Pneumoniae infection than in nonsevere pneumonia. 34) Therefore, severe or poorly treated M. pneumoniae infections should be checked for not only antibiotic resistance but also mixed infection with viruses.…”