Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

Nathan, Anna Marie; Teh, Cindy Shuan Ju; Jabar, Kartini Abdul; Teoh, Boon‐Teong; Tangaperumal, Anithaa; Westerhout, Caroline Judy; Zaki, Rafdzah Ahmad; Eg, Kah Peng; Thavagnanam, Surendran; Bruyne, Jessie Anne de

doi:10.1371/journal.pone.0228056

Cited by 30 publications

(59 citation statements)

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“…Isolation frequency between 42 and 83% has been documented in numerous health centers in Ethiopia and elsewhere in low-income countries. [22][23][24] Also, a substantial difference in the isolation rate exists between high-and low-income countries, and higher rates from numerous clinical samples were common in countries of the latter category, 25 which is consistent with the data presented in this study.…”

Section: Discussionsupporting

confidence: 91%

<p>Elevated Level of Imipenem-Resistant Gram-Negative Bacteria Isolated from Patients Attending Health Centers in North Gondar, Ethiopia</p>

Abda¹,

Adugna²,

Assefa³

2020

IDR

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Background The frequent identification of resistant bacteria in hospitals constantly presents antimicrobial therapy with a challenge. Imipenem, once considered an extremely powerful antibiotic against multidrug-resistant bacterial infections, is losing its effectiveness. Its use in empirical therapy with inadequate or nonexistent antimicrobial stewardship programs has further triggered bacterial resistance in low-income countries. Therefore, this study aimed at identifying imipenem-resistant Gram-negative bacteria from patients who were referred to health centers in North Gondar, Ethiopia. Methods A total of 153 sputum samples were used to isolate Gram-negative bacteria. The isolates, which were resistant to imipenem, were identified by standard biochemical tests and 16S rRNA sequencing. The Kirby-Bauer disk diffusion method was used to determine the sensitivity or resistance of the isolate to diverse antimicrobial agents. Results The study identified 79 imipenem-resistant bacterial isolates from eight genera with clinically relevant microorganisms, including Acinetobacter baumannii (20.77%), Klebsiella pneumoniae (19.48%), Pseudomonas aeruginosa (16.88%), and Serratia marcescens (14.28%). Overall, imipenem-resistant bacterial isolates were detected in 31 samples (20.26%). Additionally, a remarkably high level of resistance to most antibiotics was observed among isolates of Klebsiella pneumoniae and Acinetobacter baumannii . Gentamycin is the most active antibiotic against many of the isolates, while β-lactams appear to be less effective. Conclusion The study indicated that many Gram-negative bacteria were resistant to imipenem with parallel resistances to other antimicrobials. Hence, the prescription of imipenem within the region should be according to the antibiotic resistance profiles of the multi-drug resistant bacteria.

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Section: Discussionsupporting

confidence: 91%

<p>Elevated Level of Imipenem-Resistant Gram-Negative Bacteria Isolated from Patients Attending Health Centers in North Gondar, Ethiopia</p>

Abda¹,

Adugna²,

Assefa³

2020

IDR

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“…While the strict exclusion of risk populations may affect our prevalence rate, the younger age of our patients (less than 6 months) may also be the reason for higher prevalence compared to the previous African studies [ 20 – 22 ]. Additionally, other viruses and bacteria probably play a more important role in developing countries compared to western settings, where RSV has a much higher importance than other viruses and bacteria [ 2 , 29 , 31 ]. However, vaccination was up to date and almost all infants had a preceding upper respiratory infection in our study, thus bacterial etiologies were unlikely in the majority of the patients, although it was not explored adequately.…”

Section: Discussionmentioning

confidence: 99%

Respiratory syncytial virus in severe lower respiratory infections in previously healthy young Ethiopian infants

Weldetsadik

Riedel

2021

BMC Pediatr

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Background Respiratory Syncytial Virus (RSV) is the commonest cause of acute lower respiratory infections (ALRI) in infants. However, the burden of RSV is unknown in Ethiopia. We aimed to determine the prevalence, seasonality and predictors of RSV infection in young infants with ALRI for the first time in Ethiopia. Methods We performed RSV immuno-chromatographic assay from nasopharyngeal swabs of infants, 29 days to 6 months of age. We included the first 10 eligible infants in each month from June 2018 to May 2019 admitted in a tertiary pediatric center. Clinical, laboratory and imaging data were also collected, and chi-square test and regression were used to assess associated factors with RSV infection. Results Among a total of 117 study children, 65% were male and mean age was 3 months. Bronchiolitis was the commonest diagnosis (49%). RSV was isolated from 26 subjects (22.2%) of all ALRI, 37% of bronchiolitis and 11% of pneumonia patients. Although RSV infection occurred year round, highest rate extended from June to November. No clinical or laboratory parameter predicted RSV infection and only rainy season (Adjusted Odds Ratio (AOR) 10.46 [95%. C.I. 1.95, 56.18]) was independent predictor of RSV infection. Conclusions RSV was isolated in a fifth of young infants with severe ALRI, mostly in the rainy season. Diagnosis of RSV infection in our setting require specific tests as no clinical parameter predicted RSV infection. Since RSV caused less than a quarter of ALRI in our setting, the other causes should be looked for in future studies.

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“…Comparing between the severe pneumonia and non-pneumonia groups revealed that CYP with CP along with severe pneumonia were more likely to be male (62% vs. 38%, p < 0.01). According to Nathan’s children prospective cohort study, bacterial pneumonia was seen more in males [ 46 ]. We think some factors play the role in it.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study

et al. 2020

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Background Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. Methods This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1 st , 1997 and December 31 st , 2013 and followed them up through December 31 st , 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. Results Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. Conclusions The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.

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Bacterial pneumonia and its associated factors in children from a developing country: A prospective cohort study

Cited by 30 publications

References 50 publications

<p>Elevated Level of Imipenem-Resistant Gram-Negative Bacteria Isolated from Patients Attending Health Centers in North Gondar, Ethiopia</p>

<p>Elevated Level of Imipenem-Resistant Gram-Negative Bacteria Isolated from Patients Attending Health Centers in North Gondar, Ethiopia</p>

Respiratory syncytial virus in severe lower respiratory infections in previously healthy young Ethiopian infants

Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study

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