Comparison of the frequency of bacterial and viral infections among children with community-acquired pneumonia hospitalized across distinct severity categories: a prospective cross-sectional study

摘要

Background The comparison of the frequencies of bacterial and viral infections among children with community-acquired pneumonia (CAP) admitted in distinct severity categories, in an original study, is lacking in literature to-date. We aimed to achieve this goal. Methods Children aged 2-59-months-old hospitalized with CAP were included in this prospective study in Salvador, Brazil. Clinical data and biological samples were collected to investigate 11 viruses and 8 bacteria. Severity was assessed by using the World Health Organization criteria. Results One hundred eighty-one patients were classified as “non-severe” ( n =?53; 29.3?%), “severe” ( n =?111; 61.3?%), or “very severe” ( n =?17; 9.4?%) CAP. Overall, aetiology was detected among 156 (86.2?%) cases; viral ( n =?84; 46.4?%), bacterial ( n =?26; 14.4?%) and viral-bacterial ( n =?46; 25.4?%) infections were identified. Viral infection frequency was similar in severe/very severe and non-severe cases (46.1?% vs . 47.2?%; p =?0.9). Pneumococcal infection increased across “non-severe” (13.2?%), “severe” (23.4?%), and “very severe” (35.3?%) cases (qui-squared test for trend p =?0.04). Among patients with detected aetiology, after excluding cases with co-infection, the frequency of sole bacterial infection was different ( p =?0.04) among the categories; non-severe (12.5?%), severe (29.3?%) or very severe (55.6?%). Among these patients, sole bacterial infection was independently associated with severity (OR?=?4.4 [95 % CI:1.1–17.6]; p =?0.04) in a model controlled for age (OR?=?0.7 [95 % CI:0.5–1.1]; p =?0.1). Conclusions A substantial proportion of cases in distinct severity subgroups had respiratory viral infections, which did not differ between severity categories. Bacterial infection, particularly pneumococcal infection, was more likely among severe/very severe cases.