Etiology of Clinical Community-Acquired Pneumonia in Swedish Children Aged 1–59 Months with High Pneumococcal Vaccine Coverage—The TREND Study

Abstract

(1) Immunization with pneumococcal conjugate vaccines has decreased the burden of community-acquired pneumonia (CAP) in children and likely led to a shift in CAP etiology. (2) The Trial of Respiratory infections in children for ENhanced Diagnostics (TREND) enrolled children 1-59 months with clinical CAP according to the World Health Organization (WHO) criteria at Sachs’ Children and Youth Hospital, Stockholm, Sweden. Children with rhonchi and indrawing underwent “bronchodilator challenge”. C-reactive protein and nasopharyngeal PCR detecting 20 respiratory pathogens, were collected from all children. Etiology was defined according to an a priori defined algorithm based on microbiological, biochemical, and radiological findings. (3) Of 327 enrolled children, 107 (32%) required hospitalization; 91 (28%) received antibiotic treatment; 77 (24%) had a chest X-ray performed; and 60 (18%) responded to bronchodilator challenge. 243 (74%) episodes were classified as viral, 11 (3%) as mixed viral-bacterial, five (2%) as bacterial, two (0.6%) as atypical bacterial and 66 (20%) as undetermined etiology. After exclusion of children responding to bronchodilator challenge, the proportion of bacterial and mixed viral-bacterial etiology was 1% and 4%, respectively. (4) The novel TREND etiology algorithm classified the majority of clinical CAP episodes as of viral etiology, whereas bacterial etiology was uncommon. Defining CAP in children <5 years is challenging, and the WHO definition of clinical CAP is not suitable for use in children immunized with pneumococcal conjugate vaccines.

Comparison between Short Therapy and Standard Therapy in Pediatric Patients Hospitalized with Urinary Tract Infection: A Single Center Retrospective Analysis

“…Importantly, our findings and the other mentioned studies seem to be in line with new evidence about the safety of short therapy in pediatric infectious diseases, such as pneumonia [ 10 ]: a recent review considered four clinical trials [ 23 , 24 , 25 , 26 ] aimed at analyzing the optimal duration of antibiotic therapy in children affected by non-hospitalized pneumonia, the conclusions of which are the same and indicate that in uncomplicated forms 5 days of antibiotic therapy are sufficient in the eradication of the infection. A similar conclusion can be applied to hospitalized patients [ 27 ] from a large multicenter study conducted in 2022, which showed that, in uncomplicated pneumonia cases, a 13–14-day cycle (defined as extended) does not exceed a standard 5–6-day cycle in healing at one month (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81%).…”

Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

“…At least four RCTs have been performed in children presenting to ambulatory care practices with CAP (Table 1) [33,35 ▪▪ –37 ▪▪ ]. Diagnostics to confirm the presence of bacterial pathogens as the causative agent of CAP remain suboptimal in children, underscoring an important challenge in performing CAP trials in children [34]. In 2014, Greenberg and colleagues performed a clinical trial of Israeli children with outpatient CAP [33].…”

Myxovirus resistance protein A for discriminating between viral and bacterial lower respiratory tract infections in children – The TREND study

“…Antibiotics were prescribed in 91/324 cases (28%), in 60/242 (25%) of cases with viral aetiology and in 4/5 (80%) of cases with bacteral aetiology. The most commonly identified viruses in the cases were rhinovirus, RSV, and hMPV (detected in n ¼ 156, n ¼ 125, and n ¼ 32 cases, respectively) [17]. Of the children with viral LRTI who were treated with antibiotics, 21/ 60 (35%) showed signs of treatment failure.…”