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Original article

Vol. 153 No. 2 (2023)

Detection of mostly viral pathogens and high proportion of antibiotic treatment initiation in hospitalised children with community-acquired pneumonia in Switzerland – baseline findings from the first two years of the KIDS-STEP trial

  • Malte Kohns Vasconcelos
  • Patrick M. Meyer Sauteur
  • Kristina Keitel
  • Regina Santoro
  • Adrian Egli
  • Michael Coslovsky
  • Michelle Seiler
  • Marco Lurà
  • Henrik Köhler
  • Natasha Loevy
  • Christian R. Kahlert
  • Ulrich Heininger
  • Johannes van den Anker
  • Julia A. Bielicki
DOI
https://doi.org/10.57187/smw.2023.40040
Cite this as:
Swiss Med Wkly. 2023;153:40040
Published
20.02.2023

Summary

AIMS OF THE STUDY: Globally, since the introduction of conjugate-vaccines against encapsulated bacteria, respiratory viruses have caused most hospitalisations for community-acquired pneumonia. The aim of this study was to describe pathogens detected and their association with clinical findings in Switzerland.

METHODS: Baseline data were analysed for all trial participants enrolled between September 2018 and September 2020 into the KIDS-STEP Trial, a randomised controlled superiority trial on the effect of betamethasone on clinical stabilisation of children admitted with community-acquired pneumonia. Data included clinical presentation, antibiotic use and results of pathogen detection. In addition to routine sampling, nasopharyngeal specimens were analysed for respiratory pathogens using a panel polymerase chain reaction test covering 18 viral and 4 bacterial pathogens.

RESULTS: 138 children with a median age of 3 years were enrolled at the eight trial sites. Fever (obligatory for enrolment) had been present for median 5 days before admission. Most common symptoms were reduced activity (129, 93.5%) and reduced oral intake (108, 78.3%). Oxygen saturation <92% was found in 43 (31.2%). Forty-three participants (29.0%) were already on antibiotic treatment prior to admission and 104 participants (75.4%) received antibiotic treatment on admission. Pathogen testing results were available from 132 children: 31 (23.5%) had respiratory syncytial virus detected, 21 (15.9%) human metapneumovirus. The pathogens detected showed expected seasonal and age preponderance and were not associated with chest X-ray findings.

CONCLUSIONS: In the context of the predominantly viral pathogens detected, the majority of antibiotic treatment is probably unnecessary. The ongoing trial, as well as other studies, will be able to provide comparative pathogen detection data to compare pre- and post-COVID-19-pandemic settings.

References

  1. Koshy E, Murray J, Bottle A, Sharland M, Saxena S. Impact of the seven-valent pneumococcal conjugate vaccination (PCV7) programme on childhood hospital admissions for bacterial pneumonia and empyema in England: national time-trends study, 1997-2008. Thorax. 2010 Sep;65(9):770–4. https://doi.org/10.1136/thx.2010.137802 DOI: https://doi.org/10.1136/thx.2010.137802
  2. O’Brien KL, Levine OS, Knoll MD, Feikin DR, DeLuca AN, Driscoll AJ, et al. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet (London, England). 2019;394(10200):757-79. Epub 2019/07/02. doi: https://doi.org/10.1016/s0140-6736(19)30721-4. PubMed PMID: 31257127; PubMed Central PMCID: PMCPMC6727070. https://doi.org/10.1016/S0140-6736(19)30721-4 DOI: https://doi.org/10.1016/S0140-6736(19)30721-4
  3. Jain S, Finelli L; CDC EPIC Study Team. Community-acquired pneumonia among U.S. children. N Engl J Med. 2015 May;372(22):2167–8. https://doi.org/10.1056/NEJMc1504028 DOI: https://doi.org/10.1056/NEJMc1504028
  4. Kohns Vasconcelos M, Loens K, Sigfrid L, Iosifidis E, Epalza C, Donà D, et al. Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study. BMJ Open Respir Res. 2021;8(1). Epub 2021/07/31. doi: https://doi.org/10.1136/bmjresp-2021-000887. PubMed PMID: 34326154; PubMed Central PMCID: PMCPMC8323363. DOI: https://doi.org/10.1136/bmjresp-2021-000887
  5. Williams DJ, Zhu Y, Grijalva CG, Self WH, Harrell FE, Jr., Reed C, et al. Predicting Severe Pneumonia Outcomes in Children. Pediatrics. 2016;138(4). Epub 2016/10/01. doi: https://doi.org/10.1542/peds.2016-1019. PubMed PMID: 27688362; PubMed Central PMCID: PMCPMC5051209 conflicts of interest to disclose. DOI: https://doi.org/10.1542/peds.2016-1019
  6. Mazur NI, Bont L, Cohen AL, Cohen C, von Gottberg A, Groome MJ, et al.; South African Severe Acute Respiratory Illness (SARI) Surveillance Group. Severity of Respiratory Syncytial Virus Lower Respiratory Tract Infection With Viral Coinfection in HIV-Uninfected Children. Clin Infect Dis. 2017 Feb;64(4):443–50. https://doi.org/10.1093/cid/ciw756 DOI: https://doi.org/10.1093/cid/ciw756
  7. Calvo C, García-García ML, Pozo F, Paula G, Molinero M, Calderón A, et al. Respiratory Syncytial Virus Coinfections With Rhinovirus and Human Bocavirus in Hospitalized Children. Medicine (Baltimore). 2015 Oct;94(42):e1788. https://doi.org/10.1097/md.0000000000001788 https://doi.org/10.1097/MD.0000000000001788 DOI: https://doi.org/10.1097/MD.0000000000001788
  8. Kohns Vasconcelos M, Meyer Sauteur PM, Santoro R, Coslovsky M, Lurà M, Keitel K, et al. Randomised placebo-controlled multicentre effectiveness trial of adjunct betamethasone therapy in hospitalised children with community-acquired pneumonia: a trial protocol for the KIDS-STEP trial. BMJ open. 2020;10(12):e041937. Epub 2020/12/31. doi: https://doi.org/10.1136/bmjopen-2020-041937. PubMed PMID: 33376176; PubMed Central PMCID: PMCPMC7778765. DOI: https://doi.org/10.1136/bmjopen-2020-041937
  9. Kohns Vasconcelos M, Meyer Sauteur PM, Keitel K, Santoro R, Heininger U, van den Anker J, et al. Strikingly Decreased Community-acquired Pneumonia Admissions in Children Despite Open Schools and Day-care Facilities in Switzerland. Pediatr Infect Dis J. 2021 Apr;40(4):e171–2. https://doi.org/10.1097/inf.0000000000003026 https://doi.org/10.1097/INF.0000000000003026 DOI: https://doi.org/10.1097/INF.0000000000003026
  10. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al.; British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011 Oct;66 Suppl 2:ii1–23. https://doi.org/10.1136/thoraxjnl-2011-200598 DOI: https://doi.org/10.1136/thoraxjnl-2011-200598
  11. Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, et al. S2k-Leitlinie Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP). Pneumologie. 2020 Aug;74(8):515–44. https://doi.org/10.1055/a-1139-5132 DOI: https://doi.org/10.1055/a-1139-5132
  12. Keitel K, Samaka J, Masimba J, Temba H, Said Z, Kagoro F, et al. Safety and Efficacy of C-reactive Protein-guided Antibiotic Use to Treat Acute Respiratory Infections in Tanzanian Children: A Planned Subgroup Analysis of a Randomized Controlled Noninferiority Trial Evaluating a Novel Electronic Clinical Decision Algorithm (ePOCT). Clin Infect Dis. 2019 Nov;69(11):1926–34. https://doi.org/10.1093/cid/ciz080 DOI: https://doi.org/10.1093/cid/ciz080
  13. Hsia Y, Lee BR, Versporten A, Yang Y, Bielicki J, Jackson C, et al.; GARPEC and Global-PPS networks. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. Lancet Glob Health. 2019 Jul;7(7):e861–71. https://doi.org/10.1016/s2214-109x(19)30071-3 https://doi.org/10.1016/S2214-109X(19)30071-3 DOI: https://doi.org/10.1016/S2214-109X(19)30071-3
  14. Dierig A, Hirsch HH, Decker ML, Bielicki JA, Heininger U, Ritz N. Mycoplasma pneumoniae detection in children with respiratory tract infections and influence on management - a retrospective cohort study in Switzerland. Acta Paediatr. 2020;109(2):375-80. Epub 2019/06/07. doi: https://doi.org/10.1111/apa.14891. PubMed PMID: 31168877; PubMed Central PMCID: PMCPMC7159768. DOI: https://doi.org/10.1111/apa.14891
  15. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. The New England journal of medicine. 2015;372(9):835-45. Epub 2015/02/26. doi: https://doi.org/10.1056/NEJMoa1405870. PubMed PMID: 25714161; PubMed Central PMCID: PMCPMC4697461. DOI: https://doi.org/10.1056/NEJMoa1405870
  16. Williams DJ, Hall M, Gerber JS, Neuman MI, Hersh AL, Brogan TV, et al.; Pediatric Research in Inpatient Settings Network. Impact of a National Guideline on Antibiotic Selection for Hospitalized Pneumonia. Pediatrics. 2017 Apr;139(4):e20163231. https://doi.org/10.1542/peds.2016-3231 DOI: https://doi.org/10.1542/peds.2016-3231
  17. Mattila S, Paalanne N, Honkila M, Pokka T, Tapiainen T. Effect of Point-of-Care Testing for Respiratory Pathogens on Antibiotic Use in Children: A Randomized Clinical Trial. JAMA Network Open. 2022;5(6):e2216162-e. doi: https://doi.org/10.1001/jamanetworkopen.2022.16162. DOI: https://doi.org/10.1001/jamanetworkopen.2022.16162
  18. Doan Q, Enarson P, Kissoon N, Klassen TP, Johnson DW. Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database of Systematic Reviews. 2014(9). doi: https://doi.org/10.1002/14651858.CD006452.pub4. PubMed PMID: CD006452. DOI: https://doi.org/10.1002/14651858.CD006452.pub4
  19. Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, et al. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrobial resistance and infection control. 2020;9:3. Epub 2020/01/09. doi: https://doi.org/10.1186/s13756-019-0659-3. PubMed PMID: 31911831; PubMed Central PMCID: PMCPMC6942341. DOI: https://doi.org/10.1186/s13756-019-0659-3
  20. Fancourt N, Deloria Knoll M, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, et al. Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017;64(suppl_3):S262-s70. Epub 2017/06/03. doi: https://doi.org/10.1093/cid/cix089. PubMed PMID: 28575361; PubMed Central PMCID: PMCPMC5447837.
  21. Nelson KA, Morrow C, Wingerter SL, Bachur RG, Neuman MI. Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia. Pediatr Emerg Care. 2016 Aug;32(8):514–9. https://doi.org/10.1097/pec.0000000000000868 https://doi.org/10.1097/PEC.0000000000000868 DOI: https://doi.org/10.1097/PEC.0000000000000868
  22. Claes AS, Clapuyt P, Menten R, Michoux N, Dumitriu D. Performance of chest ultrasound in pediatric pneumonia. Eur J Radiol. 2017 Mar;88:82–7. https://doi.org/10.1016/j.ejrad.2016.12.032 DOI: https://doi.org/10.1016/j.ejrad.2016.12.032
  23. Loens K, Van Heirstraeten L, Malhotra-Kumar S, Goossens H, Ieven M. Optimal sampling sites and methods for detection of pathogens possibly causing community-acquired lower respiratory tract infections. Journal of clinical microbiology. 2009;47(1):21-31. Epub 2008/11/21. doi: https://doi.org/10.1128/jcm.02037-08. PubMed PMID: 19020070; PubMed Central PMCID: PMCPMC2620840. https://doi.org/10.1128/JCM.02037-08 DOI: https://doi.org/10.1128/JCM.02037-08
  24. Tschiedel E, Goralski A, Steinmann J, Rath PM, Olivier M, Mellies U, et al. Multiplex PCR of bronchoalveolar lavage fluid in children enhances the rate of pathogen detection. BMC pulmonary medicine. 2019;19(1):132. Epub 2019/07/20. doi: https://doi.org/10.1186/s12890-019-0894-7. PubMed PMID: 31319825; PubMed Central PMCID: PMCPMC6639929. DOI: https://doi.org/10.1186/s12890-019-0894-7
  25. Kohns Vasconcelos M, Renk H, Popielska J, Nyirenda Nyang'wa M, Burokiene S, Gkentzi D, et al. SARS-CoV-2 testing and infection control strategies in European paediatric emergency departments during the first wave of the pandemic. Eur J Pediatr. 2020:1-7. Epub 2020/10/15. doi: https://doi.org/10.1007/s00431-020-03843-w. PubMed PMID: 33051714; PubMed Central PMCID: PMCPMC7553380.
  26. Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, et al. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J. 2021 Jun;40(6):544–9. https://doi.org/10.1097/inf.0000000000003036 https://doi.org/10.1097/INF.0000000000003036 DOI: https://doi.org/10.1097/INF.0000000000003036
  27. Bogaert D, De Groot R, Hermans PW. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. Lancet Infect Dis. 2004 Mar;4(3):144–54. https://doi.org/10.1016/s1473-3099(04)00938-7 https://doi.org/10.1016/S1473-3099(04)00938-7 DOI: https://doi.org/10.1016/S1473-3099(04)00938-7
  28. Dal-Ré R, Janiaud P, Ioannidis JP. Real-world evidence: how pragmatic are randomized controlled trials labeled as pragmatic? BMC Med. 2018 Apr;16(1):49. https://doi.org/10.1186/s12916-018-1038-2 DOI: https://doi.org/10.1186/s12916-018-1038-2

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