Virus and Mycoplasma pneumoniae are the main etiological agents of
community-acquired pneumonia in hospitalized pediatric patients in Spain
Abstract
Objetives. To perform a description of the etiology of hospitalized
children with community-acquired pneumonia (CAP) in Spain and analyze
predictors related to etiology. Hypothesis. The different etiological
groups of pediatric CAP are associated to different clinical,
radiographic and analytical data. Design. Observational, multi-center,
prospective study. Patient selection. Patients from 1 month to 17 years
admitted because of CAP from April 2012 to May 2019. Methods. An
extensive microbiological workup was done. Clinical, radiographic and
analytical parameters were analyzed in order to differentiate viral,
atypical bacteria (AB) and typical bacteria (TyB) pneumonia. Results.
495 children were enrolled. At least one likely causative pathogen was
identified in 262 (52.9%). Pathogenic viruses in 155/262 (59.2%), AB
in 84/262 (32.1%) and TyB in 40/262 (15.3%). Consolidation was found
in 89/138 (64.5%) CAP attributed to virus only, in 74/84 (88.1%) of
CAP attributed to AB and 40/40 (100%) of CAP attributed to TyB.
Para-pneumonic pleural effusion (PPE) was found in 112/495 (22.6%)
patients, 61/112 (54.5%) with a likely causative pathogen: virus 12/61
(19.7%), AB 23/61 (37.7%) and TyB 26/61 (42.6%). Viral etiology was
significantly more frequent in younger patients and those with lower
oxygen saturation, wheezing, no-consolidation and higher lymphocyte
counts. Patients with AB were significantly more likely to have more
days of fever at admission and a higher rate of use of antibiotics
before admission. Conclusions. Viruses and AB are the main cause of
pediatric CAP in Spain. Wheezing, younger age and no-consolidation on
the X-ray support viral etiology. Viruses and AB can also cause PPE. The
use of antibiotic in pediatric CAP can be restricted.