Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia

Abstract

BackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP.MethodsData from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression.ResultsDiarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia’s rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08–0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18–18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07–25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively.ConclusionCombining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.

Antibiotic Prescribing for Lower Respiratory Tract Infections and Community-Acquired Pneumonia: An Italian Pediatric Emergency Department’s Real-Life Experience

“…Some studies show that combining clinical symptoms and blood biomarkers can improve discrimination between bacterial or viral CAP in children. For example, high CRP with fever increased specificity in distinguishing bacterial and viral pneumonia when compared to elevated CRP alone [ 28 , 29 ].…”

Plasma levels of neurogenic inflammation related neuropeptides in pediatric patients with community-acquired pneumonia and their potential diagnostic value in distinguishing viral and bacterial pneumonia

“…Patients were classified into viral and bacterial/mixed pneumonia based on serum levels of PCT, neutrophil counts and CRP values. Because it is well documented that serum levels of CRP and PCT, and neutrophil counts were higher in bacterial/mixed cases than viral cases in pediatric pneumonia although they are not yet used in clinical routine [ 9 – 11 ]. Moreover, it has previously been suggested that pneumonias with serum PCT > 800 pg/ml (= 0.8 ng/ml) can be classified as bacterial/mixed, while those with PCT < 800 pg/ml can be classified as viral [ 12 ].…”

People are an organic unity: Gut-lung axis and pneumonia

“…In another meta-analysis involving 35 studies and including 6686 COVID-19 patients, the overall incidence of gastroenterological symptoms was 15% [ 97 , 98 ]. Similarly, in a study of 124 children with CAP, diarrhea symptoms were present in about 24% and vomiting in 7.3% of cases [ 99 ]. On the other hand, patients suffering from Inflammatory Bowel Disease (IBD) had an increased prevalence of severe COVID-19 and bacterial pneumonia [ 100 , 101 ], and their risk of complications is also significantly increased [ [101] , [102] , [103] ].…”