Clinical characteristics of severe community-acquired pneumonia in children with virus mono-detection versus co-detection with bacteria.

Backgroud: By analyzing the etiological distribution and clinical characteristics of severe community-acquired pneumonia in children with virus mono-detection and co-detection with bacteria and other pathogens, to explore the clinical characteristics that can help identify mixed infections, thereby providing a basis for the more precise use of antimicrobial drugs.

Methods: A retrospective study was conducted on hospitalized children aged 1 month to 14 years with severe community-acquired pneumonia who underwent bronchoscopy in Shenzhen Children's Hospital from January to December 2018. The distribution of 19 pathogens detected by nucleic acid detection in bronchoalveolar lavage fluid was analyzed. Clinical data of children were obtained from the hospital electronic patient dossiers. Data were analyzed to describe the difference between viral mono-detection and co-detection.

Methods: A retrospective study was conducted on hospitalized children aged 1 month to 14 years with severe community-acquired pneumonia who underwent bronchoscopy in Shenzhen Children's Hospital from January to December 2018. The distribution of 19 pathogens detected by nucleic acid detection in bronchoalveolar lavage fluid was analyzed. Clinical data of children were obtained from the hospital electronic patient dossiers. Data were analyzed to describe the difference between viral mono-detection and co-detection.

Results: A total of 479 children with severe community-acquired pneumonia were enrolled from January to December 2018, at least one pathogen was detected in 375 cases (78.3%), including 247 cases (51.6%) of viruses, 111 cases (23.2%) of atypical pathogens, and 98 cases (20.5%) of bacteria. Among all positive cases, 274 cases (73.1%) had a single pathogen detected, and 101 cases (26.9%) had co-detection (≥ 2 pathogens). Among these co-detection, 51 cases (50.5%) were virus-bacteria co-detection, and 20 cases (19.8%) were virus-atypical pathogens co-detection. There was no significant difference in the detection rates of different types of pathogens between male and female patients (p > 0.05). There were no significant differences in clinical presentation, signs, inflammation and organ function indicators, pulmonary complications, antibiotic use, glucocorticoid use, intravenous immunoglobulin use, PICU admission rate, need for mechanical ventilation, and length of hospital stay among children with virus-bacteria co-detection, virus-atypical pathogens co-detection, and virus mono-detection (p > 0.05).

Conclusion: Virus-bacteria co-detection or virus-atypical pathogens co-detection are common in children with severe community-acquired pneumonia. Clinical features alone cannot distinguish between viral mono-infection and mixed bacterial or atypical pathogen infections.