Pneumonia In Pediatric Patients Research Articles

Incidence and outcomes of ventilator associated pneumonia in pediatric patients: an observational study

Background: Ventilator associated pneumonia (VAP) is very common in pediatric intensive care unit (PICU) intubated patients and also responsible for major morbidity and mortality. Usually, it develops after 48 hours of mechanically ventilated patients, its incidence increases as the duration of time increases and it is a major risk factor for VAP. The present study was carried out to know the overall incidence of VAP in mechanically ventilated patients in PICU. Methods: The study was carried out in PICU of the department of pediatrics, B. R. D. Medical College, Gorakhpur from October 2020 to October 2021. Patients aged between 1 year to 15 years were included in the study. Results: There were 50 (59.5%) patients’ male and 34 (40.5%) patients’ female under investigation. The clinical pulmonary infection score (CPIS) values ranged from the mean value of 4.38±2.30 at 36th hours to 7.33±1.92 at 96th hours of intubation. VAP was present in 23 (27.3%) patients while 62 (73.8%) patients were having no VAP. Among VAP associated patients, 14.3% were Acinetobacter positive, 5.95% were Klebsiella positive and 3.57% were E. coli positive. Conclusions: Parameters of CPIS associated with VAP revealed that Acinetobactor was comparative more common organism and the age group of 1 to 5 years was more sensitive. VAP can be reduced by decreasing the duration of mechanical ventilation.

WILL ULTRASOUND REVOLUTIONIZE THE DIAGNOSIS OF PNEUMONIA IN CHILDREN POPULATION?

Worldwide, pneumonia continues to be a major cause of morbidity and mortality in children. The effectiveness of ultrasonography and chest radiography (X-ray) in the diagnosis of pneumonia in pediatric patients is examined in this paper. Although chest radiography has been the norm for years, worries about radiation exposure have made ultrasonography seem like a viable substitute. This article assesses both modalities' diagnostic value and accuracy through a review of recent literature. As a potentially useful diagnostic tool, ultrasonography has advantages over chest X-rays, including accessibility, low radiation dose, and similar diagnostic efficacy. Ultrasound has a high negative predictive value, which indicates that it may be used to efficiently triage patients in emergencies. The decision between an X-ray and an ultrasound ultimately comes down to several variables, such as patient condition, physician skill, and equipment accessibility. However, considering ultrasound's safety record and diagnostic capabilities, it offers a strong substitute for diagnosing pneumonia in kids, in line with WHO guidelines to reduce radiation exposure in this susceptible group.

Clinical Epidemiological Characteristics and Risk Factors for Severity of SARS-CoV-2 Pneumonia in Pediatric Patients: A Hospital-Based Study in Vietnam.

Introduction Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, which can cause organ failure in several organs, cardiac problems, or acute respiratory distress syndrome (ARDS). Identifying clinical epidemiological characteristics and risk factors for complications of COVID-19 allows clinicians to diagnose and treat promptly. Objectives This study aims to describe the clinical epidemiological characteristics of COVID-19 and assess risk factors for the severity of SARS-CoV-2 pneumonia in children treated at Haiphong Children's Hospital. Methods A descriptive cross-sectional study was conducted in Haiphong Children's Hospital, Haiphong, Vietnam, for one year, from January 1, 2022, to December 31, 2022. Results In our study, 540 children were evaluated; the male-to-female ratio was 1.48/1; the median age was 23 months (IQR=6-74); Children aged under one year accounted for the highest proportion (n=202; 37.4%); 40 (7.4%) children had underlying illnesses. The number of admitted patients diagnosed with COVID-19 peaked in February 2022. Regarding severity, 380 (70.4%) cases were mild, 136 (25.2%) were moderate, only 24 (4.4%) cases were severe, and no children died. Common symptoms were fever in 483 (89.4%), coughing in 399 (73.9%), and tachypnea in 163 (30.2%) children. Laboratory features: white blood cell count, platelet count, serum CRP, and coagulation test showed little change. Around 116(21.5%) had lymphopenia and 148 (27.4%) had pneumonia. Patients under one year were approximately 1.64 times more likely to experience pneumonia complications from COVID-19 than those without such a history (OR=1.64, 95%CI = 1.12 - 2.41, p=0.0112). Patients with underlying conditions were approximately 2.08 times more likely to experience pneumonia complications from COVID-19 compared to those without such conditions (OR=2.08, 95%CI =1.08 - 4.02, p=0.0289). Conclusion In COVID-19 pediatric patients, the severity of the disease was mild to moderate without any mortality. Children aged under one year accounted for the highest proportion of all COVID-19 patients. This study found that age under one year and underlying illnesses are related to pneumonia in COVID-19 pediatric patients.

Antimicrobial resistance prediction by clinical metagenomics in pediatric severe pneumonia patients

BackgroundAntimicrobial resistance (AMR) is a major threat to children’s health, particularly in respiratory infections. Accurate identification of pathogens and AMR is crucial for targeted antibiotic treatment. Metagenomic next-generation sequencing (mNGS) shows promise in directly detecting microorganisms and resistance genes in clinical samples. However, the accuracy of AMR prediction through mNGS testing needs further investigation for practical clinical decision-making.MethodsWe aimed to evaluate the performance of mNGS in predicting AMR for severe pneumonia in pediatric patients. We conducted a retrospective analysis at a tertiary hospital from May 2022 to May 2023. Simultaneous mNGS and culture were performed on bronchoalveolar lavage fluid samples obtained from pediatric patients with severe pneumonia. By comparing the results of mNGS detection of microorganisms and antibiotic resistance genes with those of culture, sensitivity, specificity, positive predictive value, and negative predictive value were calculated.ResultsmNGS detected bacterial in 71.7% cases (86/120), significantly higher than culture (58/120, 48.3%). Compared to culture, mNGS demonstrated a sensitivity of 96.6% and a specificity of 51.6% in detecting pathogenic microorganisms. Phenotypic susceptibility testing (PST) of 19 antibiotics revealed significant variations in antibiotics resistance rates among different bacteria. Sensitivity prediction of mNGS for carbapenem resistance was higher than penicillins and cephalosporin (67.74% vs. 28.57%, 46.15%), while specificity showed no significant difference (85.71%, 75.00%, 75.00%). mNGS also showed a high sensitivity of 94.74% in predicting carbapenem resistance in Acinetobacter baumannii.ConclusionsmNGS exhibits variable predictive performance among different pathogens and antibiotics, indicating its potential as a supplementary tool to conventional PST. However, mNGS currently cannot replace conventional PST.

Evaluation of Biofire FilmArray Pneumonia Panel in Diagnosis of Pneumonia in Pediatric Patients in Intensive Care Unit in comparison to VITEK 2 Compact system and Routine Culture Methods

Evaluation of Biofire FilmArray Pneumonia Panel in Diagnosis of Pneumonia in Pediatric Patients in Intensive Care Unit in comparison to VITEK 2 Compact system and Routine Culture Methods

Hospital Outcomes Among Children With Congenital Heart Disease and Adenovirus Pneumonia.

The aim of the study is to evaluate the mortality risk factors and hospitalization outcomes of adenovirus pneumonia in pediatric patients with congenital heart disease. In this retrospective multicenter cohort study utilizing the Pediatric Health Information System database, we analyzed congenital heart disease patients with adenovirus pneumonia from January 2004 to September 2018, categorizing them into shunts, obstructive lesions, cyanotic lesions and mixing lesions. Multivariate logistic regression analysis was employed to identify mortality risk factors with 2 distinct models to mitigate collinearity issues and the Mann-Whitney U test was used to compare the hospital length of stay between survivors and nonsurvivors across these variables. Among 381 patients with a mean age of 3.2 years (range: 0-4 years), we observed an overall mortality rate of 12.1%, with the highest mortality of 15.1% noted in patients with shunts. Model 1 identified independent factors associated with increased mortality, including age 0-30 days (OR: 8.13, 95% CI: 2.57-25.67, P < 0.005), sepsis/shock (OR: 3.34, 95% CI: 1.42-7.83, P = 0.006), acute kidney failure (OR: 4.25, 95% CI: 2.05-13.43, P = 0.0005), shunts (OR: 2.95, 95% CI: 1.14-7.67, P = 0.03) and cardiac catheterization (OR: 6.04, 95% CI: 1.46-24.94, P = 0.01), and Model 2, extracorporeal membrane oxygenation (OR: 3.26, 95% CI: 1.35-7.87, P = 0.008). Nonsurvivors had a median hospital stay of 47 days compared to 15 days for survivors. The study revealed a 12.1% mortality rate in adenoviral pneumonia among children with congenital heart disease, attributed to risk factors such as neonates, sepsis, acute kidney failure, shunts, cardiac catheterization, extracorporeal membrane oxygenation use and a 3-fold longer hospital stay for nonsurvivors compared to survivors.

Clinical and Epidemiological Assessment of Children and Adolescents Hospitalized with SARS-CoV-2 in the Pre-Amazon Region.

SARS-CoV-2 infection usually presents similarly to other respiratory viral pathogens. Children and adolescents do not present as a group that is highly affected by the disease, having low infection rates. However, limited publications are associated with the findings of pneumonia in pediatric patients with COVID-19. To analyze the clinical and epidemiological aspects of children and adolescents hospitalized with SARS-CoV-2 in a pre-Amazon region. A retrospective study, carried out in four public hospitals in São Luís, Brazil where medical records of children and adolescents aged from 0 to 13 years, of both sexes, with clinical diagnosis of community-acquired pneumonia were evaluated from March 2020 to March 2021. Almost 40.0% of children were aged between 1 year and 5 years. Of the 128 children who had SARS-CoV-2, 3 are of indigenous ethnicity. Additionally, 78.6% of the children had fever and there was no significant difference between COVID-19 patients and those of other respiratory viruses. Eighteen patients had chronic neurological disease, which is the most common comorbidity observed in patients with coronavirus infection. Ground glass opacity attenuation was observed in 24.8% of children and adolescents with COVID-19. Anemia and increased inflammatory response markers were related to SARS-CoV-2 infection. More than 90.0% of patients admitted to hospital, regardless of etiology, were treated with antibiotics. Eighteen patients died. Pediatric multisystem inflammatory syndrome (PMIS) was diagnosed in 17 patients. SARS-CoV-2 in children and adolescents is mild, but the condition of patients with PMIS is more serious, with an increase in inflammatory biomarkers which can lead to death. Therefore, rapid diagnosis and differentiation of agents causing respiratory diseases are necessary for better therapeutic decision making, since the results of this study make us question the excessive use of antibiotics without meeting well-defined clinical-epidemiological criteria.

Serum Levels of IL-21, IL-23 and 8-hydroxy-2′-deoxyguanosine in Pediatric Severe Pneumonia Cases

Background: Pneumonia causes the majority of acute respiratory distress syndrome (ARDS) cases. The microbes that cause pneumonia are very diverse. In addition to DNA, RNA viruses, Gram-negative and Gram-positive bacteria cause two types of cytokine imbalances, anti-inflammatory and pro-inflammatory. It can also influence the progno-sis of sepsis and other infectious diseases. This study aims to search for 8-hydroxy-2'-deoxyguanosine (8-OHdG), IL-21, IL-23, and c-reactive protein (CRP) and compare cytokine levels. It is also to determine if Pediatric pneumonia patients CRP and cytokine levels correlate with results. Materials and Methods: In the study, blood was drawn from approximately 43 pediatric pneumonia patients and 43 healthy controls who came to the pediatric clinic to investigate serum IL-21, IL-23, 8-OHdG, and CRP levels. The levels of biomarkers were determined by ELISA method. Serum CRP levels were measured using the ATELLICA IM Analyzer. Results: Serum CRP, 8-OHdG, IL-21 and IL-23 levels were significantly higher in the pediatric pneumonia patient group than in the control group. Conclusions: Increased serum IL-21, IL-23, 8-OHdG and CRP expression in pediatric pneumonia patients is a poten-tial determinant suggesting that IL-21, IL-23-related cytokines may play a role in endothelial cell activation reported in patients. Increased 8-OHdG oxidative stress is more pronounced in patients without pediatric pneumonia while pro inflammatory cytokines are higher in pediatric pneumonia patients. However, it is used as a possible therapeu-tic target to reduce inflammation. Further study on the impact of these findings on comorbidities with larger num-ber test size is needed

Prevalence, Symptoms, and Treatment of Bronchiolitis and Pneumonia in Pediatric Patients

Background: Pediatric respiratory diseases, particularly pneumonia and bronchiolitis, pose significant health challenges worldwide. Understanding their prevalence, symptomatology, and effective treatment is crucial for improving pediatric health outcomes. Objective: This study aimed to investigate the occurrence, symptoms, and treatment outcomes of pneumonia and bronchiolitis in children under five years of age at the GKMC Swabi Department of Pediatrics. Methods: The study design was retrospective study, conducted from January 2022 to January 2023, at GKMC Swabi Department of Paediatrics included 100 pediatric patients diagnosed with either pneumonia (n=40) or bronchiolitis (n=60). Patients aged 0 to 10 years with respiratory symptoms indicative of these diseases were selected, excluding those with severe comorbidities or chronic respiratory disorders. Data on demographic characteristics, clinical symptoms, diagnostic test results, and treatment outcomes were collected from medical records. Diagnosis was based on clinical examination, chest Xrays, blood tests, and other relevant procedures. Descriptive statistics were used for data analysis, utilizing SPSS version 25. Results: The mean age of patients was 3.2 years (±0.5). Gender distribution was equal, with a 50/50 maletofemale ratio. Bronchiolitis and pneumonia accounted for 60% and 40% of cases, respectively. Common symptoms included cough (88%), fever (80%), and difficulty in breathing (65%). The positive treatment response was observed in 77.5% of cases, with 32.5% requiring hospitalization. The average duration of hospital stay was 5.0 days (±1.3). Secondary symptoms like wheezing (35%), chest pain (17.5%), runny nose (32.5%), and vomiting (17.5%) were also noted. Conclusion: The study highlights the significant burden of pneumonia and bronchiolitis in young children and the effectiveness of current treatment modalities. The findings emphasize the need for early recognition and treatment of these diseases, along with continued research into preventive measures and longterm outcomes. Keywords: Pediatric Respiratory Diseases, Pneumonia, Bronchiolitis, Child Health, Hospitalization, Treatment Outcomes.

Diagnostic Accuracy of Lung Ultrasound in Diagnosis of Pneumonia in Children using Chest X-RAY as Gold Standard

Objective: To determine the diagnostic accuracy of lung ultrasound (LUS) in the diagnosis of pneumonia in children using chest x-ray as the gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Sialkot Pakistan, from Feb to Aug 2021 Methodology: All patients underwent clinical examination, chest radiograph (anterior-posterior view), lung ultrasound and blood sample analysis in the first 24 hours after admission. A pre-specified hospital radiologist carried out a lung ultrasound. The examination was performed with the patient sitting upright or supine. The presence of pneumonia on x-ray and USG were recorded. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasound in the diagnosis of pneumonia by taking chest x-ray as the gold standard was calculated in all the study participants. Results: In this study, 262 patients with clinical features of pneumonia were enrolled. The mean age of the study participants was 3.27±2.344 years. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and frequency of lung ultrasonography (US) vs chest radiography (CR) in diagnosing pneumonia was 95.28%, 87.5%, 99.59%, 36.84%, 95.04% and 96.95% respectively. Conclusion: Lung ultrasound emerged as a sensitive diagnostic tool to diagnose pneumonia in children. Sensitivity, specificity, positive predictive value, and negative predictive value all favoured the use of this modality to diagnose pneumonia in paediatric patients.

Analysis of Nursing Clinical Practice with Chest Physiotherapy Innovation Intervention and Pronation Position on Airway Clearance in Pediatric Patients with Pneumonia in The Keruing Room

Introduction: Pneumonia is also known as "the forgotten killer of children". Based on the 2018 Riskesdas report, the age prevalence of pneumonia among children aged 1-5 years was 2.1%. The prevalence of pneumonia in toddlers and children based on gender characteristics was (2.1%) in males and (2.0%) in females. After observations and interviews in the Keruing room of Harapan Insan Sendawar Hospital, it was found that the innovative intervention of chest physiotherapy and pronation position to improve airway clearance in pediatric patients with pneumonia had never been carried out. Objective: The purpose of KIAN is to analyze the intervention of providing chest physiotherapy actions and pronation positions on improving airway clearance in pneumonia patients in the Keruing room. Methods: Sampling in this KIAN was selected according to the inclusion criteria desired by the researcher with a total sample size of five pneumonia clients. Results and Discussion: From the results of the study, it was found that the provision of chest physiotherapy and a pronated position had changes in secretion production, breath sounds, oxygen saturation (SPO2), pulse and respiratory frequency (RR) in the five patients. So that the intervention of chest physiotherapy innovation and a pronated position is very effective in dealing with airway cleansing in pediatric pneumonia patients. Conclusion: Chest physiotherapy intervention and pronation position can reduce secretion production and increase SPO2 in paediatric pneumonia patients

Chlamydophila pneumoniae-associated community-acquired pneumonia in paediatric patients of a tertiary care hospital in Mexico: molecular diagnostic and clinical insights

Chlamydophila pneumoniae is a cause of community-acquired pneumonia (CAP) and responsible for 1–2% of cases in paediatric patients. In Mexico, information on this microorganism is limited. The aim of this study was to detect C. pneumoniae using two genomic targets in a real-time PCR and IgM/IgG serology assays in paediatric patients with CAP at a tertiary care hospital in Mexico City and to describe their clinical characteristics, radiological features, and outcomes. A total of 154 hospitalized patients with diagnosis of CAP were included. Detection of C. pneumoniae was performed by real-time PCR of the pst and arg genes. Complete blood cell count, C-reactive protein measurement and IgM and IgG detection were performed. Clinical-epidemiological and radiological data from the patients were collected. C. pneumoniae was detected in 25 patients (16%), of whom 88% had underlying disease (P = 0.014). Forty-eight percent of the cases occurred in spring, 36% in girls, and 40% in children older than 6 years. All patients had cough, and 88% had fever. Interstitial pattern on chest-X-ray was the most frequent (68%), consolidation was observed in 32% (P = 0.002). IgM was positive in 7% and IgG in 28.6%. Thirty-six percent presented complications. Four percent died. A high proportion showed co-infection with Mycoplasma pneumoniae (64%). This is the first clinical report of C. pneumoniae as a cause of CAP in Mexican paediatric patients, using two genomic target strategy and serology. We found a frequency of 16.2% with predominance in children under 6 years of age. In addition; cough and fever were the most common symptoms. Early detection of this pathogen allows timely initiation of specific antimicrobial therapy to reduce development of complications. This study is one of the few to describe the presence of C. pneumoniae in patients with underlying diseases.

Cost-Effectiveness Analysis Of Ceftriaxone-Gentamicin And Ampicillin-Gentamicin In Pediatric Pneumonia At Hospital X Madiun

Pneumonia is an infectious disease caused by bacteria characterized by fever, chills, coughing up phlegm, and breathing difficulty. Generally pneumonia is caused by an infection of Streptococcus pneumoniae bacteria. Antibiotics is a therapy used in pediatric pneumonia patients at hospitals X. in Madiun. This study aims to determine a more cost-effective antibiotics therapy combination between ceftriaxone-Gentamicin and Ampicillin-Gentamicin in pediatric pneumonia patients at Hospital X in Madiun in 2019-2021. This study used a cross sectional design and data collection was carried out retrospectively. There were 39 patients as samples who were pediatric patients aged ≤ 12 years who were adjusted to the inclusion criteria. The datawere identified using decision trees and analyzed cost-effectiveness with ACER and ICER calculations. The ACER value of Ceftriaxone-Gentamicin antibiotic therapy is IDR 6,047,334.23, which is lower than Ampicillin-Gentamicin therapy whch is of IDR 9,730,746.21, thus showing that Seftriaxone-Gentamicin is more cost-effective than Ampicillin-Gentamicin. The ICER calculation has negative result of Idr 500,953.74 so it shows that the Ceftriaxone-Gentamicin combination antibiotic is more cost-effective.

Importance of early follow‐up of Mycoplasma pneumoniae pneumonia in pediatric patients: A case series

Importance of early follow‐up of <i>Mycoplasma pneumoniae</i> pneumonia in pediatric patients: A case series

The Microbiological Profile of Community-Acquired Pneumonia in Pediatric Patients in Brazil

Aims: Identifying the main pathogens causing Community Acquired Pneumonia in the pediatric population.&#x0D; Study Design: It is a narrative review, a qualitative study.&#x0D; Place and Duration of Study: Multidisciplinary Laboratory of Scientific Design and Writing (LaMDEC), Julio Bandeira University Hospital (HUJB), Cajazeiras, Paraíba, Brazil, from May 2023 to June 2023.&#x0D; Methodology: A narrative literature review method was adopted, with research carried out in the following databases: Google Scholar, Scientific Scientific Electronic Library Online (SciELO), PubMed, LILACS and Virtual Health Library (BVS).&#x0D; Results: A relevant prevalence of the bacterial pathogens Streptococcus pneumoniae, Mycoplasma pneumoniae and Staphylococcus aureus, and the viral etiological agent Respiratory Syncytial Virus, depending on the age of the affected patients, was observed in the literature in the pediatric population.&#x0D; Conclusion: A relevant prevalence of the bacterial pathogens Streptococcus pneumoniae, Mycoplasma pneumoniae and Staphylococcus aureus, and the viral etiological agent Respiratory Syncytial Virus, depending on the age of the affected patients, was observed in the literature in the pediatric population. However, the means used to confirm the etiology are still lacking in their methodological reliability, a fact that makes it important for the scientific community to develop and adopt more effective methods for the microbiological determination of the causes of pneumonia.

Applying Artificial Intelligence to Pediatric Chest Imaging: Reliability of Leveraging Adult-Based Artificial Intelligence Models

ObjectiveThe scarcity of artificial intelligence (AI) applications designed for use in pediatric patients can cause a significant health disparity in this vulnerable population. We investigated the performance of an adult-trained algorithm in detecting pneumonia in a pediatric population to explore the viability of leveraging adult-trained algorithms to accelerate pediatric AI research. MethodsWe analyzed a publicly available pediatric chest x-ray dataset using an AI algorithm from TorchXRayVision. A 60% threshold was used to make binary predictions for pneumonia presence. Predictions were compared with dataset labels. Performance measures including true-positive rate, false-positive rate, true-negative rate, false-negative rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value, accuracy, and F1-score were calculated for the complete dataset and bacterial and viral pneumonia subsets. ResultsOverall (n = 5,856), the algorithm identified 3,923 cases with pneumonia (67.00%) and 1,933 (33.00%) normal cases. In comparison with the actual image labels, there were 3,411 (58.25%) true-positive cases, 512 (8.74%) false-positive cases, 1,071 (18.29%) true-negative cases, and 862 (14.72%) false-negative cases resulting in 79.83% sensitivity, 67.66% specificity, 86.95% PPV, 55.41% negative predictive value, and 76.54% accuracy and an F1-score of 0.83. Although the performance remained consistent in the bacterial pneumonia group, there was a significant decrease in PPV (69.9%) and F1-score (0.74) in the viral pneumonia group. ConclusionAn adult-trained model adequately detected pneumonia in pediatric patients aged 1 to 5 years. Though models trained exclusively on pediatric images performed better, leveraging adult-based algorithms and datasets can expedite pediatric AI research.

Plasma IL-10, IL-19 and IL-32 are Potential Biomarkers for adenovirus-induced Severe Pneumonia in Pediatric Patients

Aim: This study aimed to identify potential plasma biomarkers for severe pediatric adenovirus (AdV) infection. Methods: Thirty-seven inflammatory proteins were measured in the plasma of AdV-infected, influenza H3N2-infected or healthy pediatric participants and the prediction values of selected inflammatory proteins for AdV and severe AdV were assessed. Results: The expression profiles of AdV- and H3N2-infected patients were largely similar, with only IL-2, IL-10, IL-19 and IL-32 showing pathogen-dependent expression. IL-10, IL-19 and IL-32, both individually and in combination, could predict AdV and severe AdV infection. Conclusion: Plasma IL-10, IL-19 and IL-32 are potential biomarkers for AdV, especially severe AdV in pediatric patients.

Drug Utilization Pattern in Pneumonia among Pediatric Patients at a Tertiary Care Hospital

INTRODUCTION: Pneumonia remains the leading cause of hospitalization and mortality in young children in low and middle-income countries like Nepal. Antibiotics are commonly prescribed for pediatric pneumonia patients. To prevent antimicrobial resistance, antibiotics must be prescribed rationally. Therefore, the purpose of this study was to evaluate the drug utilization pattern in pediatric pneumonia patients at a tertiary care hospital by using World Health Organization (WHO) prescribing indicators. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted among pediatric pneumonia patients at Universal College of Medical Sciences, Bhairahawa, Nepal from December 2022 to May 2023. Ethical approval was taken from the Institutional Review Committee (UCMS/IRC/191/22) and the purposive sampling method was used. Data were collected from pro-forma to assess WHO prescribing indicators and analyzed in Statistical Package for Social Sciences (SPSS) version 20 program and expressed as frequency and percentage for all variables. RESULTS: A total of 1408 drugs were prescribed to 196 prescriptions or patients. The average number of drugs per prescription was 7.18. The most common 51.5% of prescriptions contain 4-5 drugs per prescription. The percentage of prescriptions with antibiotics and injections was 100% respectively. Drugs prescribed by generic name were 44.24% and those matched to the national Essential Drugs List of Nepal were 53.19%. Cephalosporins (86.7%) were the most frequently prescribed antibiotics followed by aminoglycosides (79.1%). All the antibiotics were given parenterally (100%). CONCLUSIONS: The study reported inadequate compliance with WHO prescribing indicators and recommended policy formulation and application by regulatory agencies to promote the drug utilization study.

Cost-minimization analysis of pneumonia treatment in Indonesia

Pneumonia is one of the significant causes of death in developing countries, including Indonesia. As the capital of West Java, Bandung is one of the cities with the highest pneumonia cases in this province. The objective of this study was to conduct cost-minimization analysis of pneumonia treatment in Indonesia by using one of the private hospitals in Bandung as a reference case. The use of cefuroxime and ceftizoxime was considered in adult hospitalized patients. In addition, ampicillin-sulbactam and ceftriaxone usage was compared in pediatric hospitalized patients. A cross-sectional descriptive study was applied by collecting data retrospectively from medical records of adult and pediatric patients who met the inclusion criteria at one of the private hospitals in Bandung from January 2017 to December 2018. We applied the following inclusion criteria: (i) adult (&amp;gt; 20 years old) and pediatric (0–5 years old) patients who were diagnosed with pneumonia; and (ii) adult patients who received cefuroxime or ceftizoxime antibiotic therapy and pediatric patients who received ampicillin-sulbactam or ceftriaxone antibiotic therapy. We excluded patients who were diagnosed with any other co-morbidities and who did not complete the treatment. The result showed that drug cost was the primary contributor to total treatment cost in adult and pediatric patients. We calculated the average total treatment cost with ceftizoxime and cefuroxime in adult patients at $149.39 and $193.05, respectively, and the average total treatment cost with ampicillin-sulbactam and ceftriaxone in pediatric patients at $202.83 and $192.77, respectively. We also estimated the LoS in a group of ceftizoxime and cefuroxime in adult patients at 3.8 and 4.1 days, respectively, and the LoS in a group of ampicillin-sulbactam and ceftriaxone in pediatric patients at 3.9 and 5.3 days, respectively. In conclusion, using ceftizoxime to treat hospitalized pneumonia in adult patients would require less cost and yield shorter LoS than cefuroxime. Using ampicillin-sulbactam to treat hospitalized pneumonia in pediatric patients would require higher costs and yield shorter LoS than ceftriaxone.

Metagenomic-based pathogen surveillance for children with severe pneumonia in pediatric intensive care unit.

Pneumonia is a significant cause of morbidity and mortality in children. Metagenomic next-generation sequencing (mNGS) has the potential to assess the landscape of pathogens responsible for severe pulmonary infection. Bronchoalveolar lavage fluid (BALF) samples of 262 children with suspected pulmonary infections were collected from April 2019 to October 2021 in the Pediatric Intensive Care Unit (PICU) of Guangdong Women and Children Hospital. Both mNGS and conventional tests were utilized for pathogen detection. A total of 80 underlying pathogens were identified using both mNGS and conventional tests. Respiratory syncytial virus (RSV), Staphylococcus aureus and rhinovirus were the most frequently detected pathogens in this cohort. The incidence rate of co-infection was high (58.96%, 148/251), with bacterial-viral agents most co-detected. RSV was the main pathogen in children younger than 6 months of age, and was also commonly found in older pediatric patients. Rhinovirus was prevalent in children older than 6 months. Adenovirus and Mycoplasma pneumoniae were more prevalent in children older than 3 years than in other age groups. Pneumocystis jirovecii was detected in nearly 15% of children younger than 6 months. Besides, influenza virus and adenovirus were rarely found in 2020 and 2021. Our study highlights the importance of using advanced diagnostic techniques like mNGS to improve our understanding of the microbial epidemiology of severe pneumonia in pediatric patients.