Etiologic Features of Respiratory Tract Infections Seen in Children with Primary Nephrotic Syndrome: A Cross-Sectional Retrospective Study

Abstract

Background: Respiratory tract infections (RTI) are common complications of primary nephrotic syndrome (PNS) and influence the outcomes of PNS. The pathogenic spectrum and their susceptibility to antibiotics in RTI change over time, which increases the difficulty of treatment. Objectives: To improve the curative effect of RTI in children with PNS, we conducted a cross-sectional retrospective study in 2740 children with PNS to study the etiologic features of RTI seen in PNS children. Methods: Totally 2740 children with PNS hospitalized during 2010 - 2014 were enrolled in this study. Respiratory specimens were collected for the detection of pathogens using current laboratory diagnostic tests. The cases were divided into community-acquired respiratory tract infection (CARTI) and hospital-acquired respiratory tract infection (HARTI) as well as upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) to analyse the etiologic features. Results: Among 2162 cases of PNS with RTI, 2095 cases were CARTI (96.90%), and 67 cases were HARTI (3.10%). The most common pathogen in CARTI was Coxsackie virus, followed by Mycoplasma pneumoniae, respiratory syncytial virus, and Streptococcus pneumoniae, while the most common pathogen in HARTI also was Coxsackie virus, followed by respiratory syncytial virus, Mycoplasma pneumoniae, and Streptococcus pneumoniae. There was significant difference in the positive rates of Pseudomonas aeruginosa and Candida albicans between CARTI and HARTI. The distribution of pathogens differed between URTI and LRTI in children with PNS. The positive rates of most pathogens were lower in URTI than URTI. Generally, the isolation rate of extended-spectrum β-lactamase (ESBL) producing bacteria was relatively low. In CARTI, the sensitive rates of Gram-negative ESBL producing bacteria to carbapenems, amoxicillin/clavulanate potassium, ampicillin/sulbactam, and ciprofloxacin were more than 90.00%, while Gram-positive ESBL producing bacteria were sensitive to glycopeptides, linezolid, macrodantin, mupirocin-HL, and amoxicillin/clavulanate potassium. Conclusions: In children with PNS, the etiology differed between CARTI and HARTI as well as URTI and LRTI. Therefore, it is necessary to differentiate these features for empirical therapy. If the pathogen is bacterial, amoxicillin/clavulanate potassium could be the first choice before sputum culture results are available.