Etiological structure of community-acquired pneumonia in children

Le résumé fourni par la source

Community-acquired pneumonia in children remains one of the leading infectious causes of mortality, its etiological structure is constantly changing. A high proportion of pneumonias with an unspecified pathogen is characteristic of the Republic of Belarus that complicates the rational selection of initial therapy and contributes to the growth of antibiotic resistance.A retrospective cohort study of 485 clinical records of children aged 0 to 17 years with confirmed community-acquired pneumonia was conducted. Bacteriological culture, polymerase chain reaction (PCR) of respiratory tract samples, and enzyme-linked immunosorbent assay (ELISA) for IgM/IgG antibodies to M. pneumoniae and C. pneumoniae were used for etiologic diagnosis.In 64,9% of cases, the etiology was not identified. Among cases with an established etiology, respiratory viruses predominated in children under 5 years of age (60,9%), Mycoplasma pneumoniae predominated in children aged 10 years and older (78,3%), while in the 5–9 years ago group, no single pathogen showed a clear predominance (M. pneumoniae — 48,1%, respiratory viruses — 29,6%, typical bacteria and mixed infections — 11,1% respectively).The identified age-related pattern, combined with the high proportion of cases with unidentified etiology, allows the proposal of three clinical-therapeutic strategies. In children under 5 years of age, antibiotic use should be limited in the absence of firm indications. In children aged 10–17 years, macrolides are the preferred choice for initial therapy. In the 5–9 years age group, diagnostic investigation is necessary, including mandatory assessment of inflammatory biomarkers and pathogen verification.

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