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Multicenter Study
. 2022 Jun 21;12(6):e057957.
doi: 10.1136/bmjopen-2021-057957.

Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study

Dewi Lokida  1 , Helmia Farida  2 , Rina Triasih  3 , Yan Mardian  4 , Herman Kosasih  5 , Adhella Menur Naysilla  5 , Arif Budiman  1 , Chakrawati Hayuningsih  1 , Moh Syarofil Anam  2 , Dwi Wastoro  2 , Mujahidah Mujahidah  3 , Setya Dipayana  2 , Amalia Setyati  3 , Abu Tholib Aman  3 , Nurhayati Lukman  5 , Muhammad Karyana  6 , Ahnika Kline  7 , Aaron Neal  7 , Chuen-Yen Lau  8 , Clifford Lane  7
Affiliations
Multicenter Study

Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study

Dewi Lokida et al. BMJ Open. .

Abstract

Objective: To identify aetiologies of childhood community-acquired pneumonia (CAP) based on a comprehensive diagnostic approach.

Design: 'Partnerships for Enhanced Engagement in Research-Pneumonia in Paediatrics (PEER-PePPeS)' study was an observational prospective cohort study conducted from July 2017 to September 2019.

Setting: Government referral teaching hospitals and satellite sites in three cities in Indonesia: Semarang, Yogyakarta and Tangerang.

Participants: Hospitalised children aged 2-59 months who met the criteria for pneumonia were eligible. Children were excluded if they had been hospitalised for >24 hours; had malignancy or history of malignancy; a history of long-term (>2 months) steroid therapy, or conditions that might interfere with compliance with study procedures.

Main outcomes measures: Causative bacterial, viral or mixed pathogen(s) for pneumonia were determined using microbiological, molecular and serological tests from routinely collected specimens (blood, sputum and nasopharyngeal swabs). We applied a previously published algorithm (PEER-PePPeS rules) to determine the causative pathogen(s).

Results: 188 subjects were enrolled. Based on our algorithm, 48 (25.5%) had a bacterial infection, 31 (16.5%) had a viral infection, 76 (40.4%) had mixed bacterial and viral infections, and 33 (17.6%) were unable to be classified. The five most common causative pathogens identified were Haemophilus influenzae non-type B (N=73, 38.8%), respiratory syncytial virus (RSV) (N=51, 27.1%), Klebsiella pneumoniae (N=43, 22.9%), Streptococcus pneumoniae (N=29, 15.4%) and Influenza virus (N=25, 13.3%). RSV and influenza virus diagnoses were highly associated with Indonesia's rainy season (November-March). The PCR assays on induced sputum (IS) specimens captured most of the pathogens identified in this study.

Conclusions: Our study found that H. influenzae non-type B and RSV were the most frequently identified pathogens causing hospitalised CAP among Indonesian children aged 2-59 months old. Our study also highlights the importance of PCR for diagnosis and by extension, appropriate use of antimicrobials.

Trail registration number: NCT03366454.

Keywords: epidemiology; infectious diseases; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Subject screening, enrolment and monitoring flow chart. CAP, community-acquired pneumonia; CRP, C reactive protein; CXR, chest X-ray; PCT, procalcitonin; RR, respiratory rate.
Figure 2
Figure 2
Pathogen distribution. (A) Overall proportion of identified viral/bacterial/mixed pathogen, (B) Viral/bacterial/mixed pathogens by age group, (C) pattern of detection of the ten most identified pathogens, (D) distribution of 10 most identified pathogens by age group. *P<0.05. hMPV, human metapneumovirus; RSV, respiratory syncytial virus.
Figure 3
Figure 3
Distribution of the (A) monthly count and (B) seasonal pattern of infection caused by Haemophilus influenzae non-type B, RSV, Klebsiella pneumoniae, Streptococcus pneumoniae and influenza virus during a 27-month study period. RSV, respiratory syncytial virus.
See this image and copyright information in PMC

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