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. 2018 Jan 17;8(1):995.
doi: 10.1038/s41598-018-19386-y.

Recurrent wheezing in neonatal pneumonia is associated with combined infection with Respiratory Syncytial Virus and Staphylococcus aureus or Klebsiella pneumoniae

Qin Zhong  1   2   3 , Hui Feng  1   2   3 , Qi Lu  4   5   6   7 , Xu Liu  1   2   3 , Qi Zhao  1   2   3 , Yue Du  1   2   3 , Xian-Hong Zhang  1   2   3 , Jia-Rong Wang  1   2   3
Affiliations

Recurrent wheezing in neonatal pneumonia is associated with combined infection with Respiratory Syncytial Virus and Staphylococcus aureus or Klebsiella pneumoniae

Qin Zhong et al. Sci Rep. .

Abstract

Both viral and bacterial infections can be associated with wheezing episodes in children; however, information regarding combined infections with both viral and bacterial pathogens in full term neonates is limited. We sought to investigate the effects of viral-bacterial codetection on pneumonia severity and recurrent wheezing. A retrospective cohort study was conducted on neonates admitted to our hospital with pneumonia from 2009 to 2015. Of 606 total cases, 341 were diagnosed with RSV only, and 265 were diagnosed with both RSV and a potential bacterial pathogen. The leading four species of bacteria codetected with RSV were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Enterobacter cloacae. Neonates with RSV and a potential bacterial pathogen were significantly more likely to have worse symptoms, higher C-reactive protein values and more abnormal chest x-ray manifestations with Bonferroni correction for multiple comparisons (P < 0.01). On Cox regression analysis, an increased risk of recurrent wheezing was found for neonates positive for RSV-Staphylococcus aureus and RSV-Klebsiella pneumoniae. Our findings indicate that the combination of bacteria and RSV in the neonatal airway is associated with more serious clinical characteristics. The presence of RSV and Staphylococcus aureus or Klebsiella pneumoniae may provide predictive markers for wheeze.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Enrollment and outcomes. We studied 606 neonates, 52 (8.6%) neonates were lost to follow up, 554 neonates had follow-up results. n0 = number of neonates who were followed up, n1 = number of neonates who had recurrent wheezing. n2 = number of neonates who had allergic rhinitis, n3 = number of neonates who had eczema.
Figure 2
Figure 2
Odds ratio for recurrent wheezing, allergic rhinitis and eczema. Logistic regression analysis: According to the results of telephone interview of RSV only and RSV with bacteria. Odds ratios were adjusted for the following possible confounders: sex, caesarean section, allergic history, family history of allergies, educational background of mother, living conditions, antibiotic therapy before admission, feeding option, follow-up time, age, gestational age at birth, weight, birth weight. (●P<0.05).
Figure 3
Figure 3
Cumulative risk of recurrent wheezing for neonates with RSV only VS RSV–Klebsiella pneumoniae and RSV only VS RSV–Staphylococcus aureus.
See this image and copyright information in PMC

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