Article Text

Original research
Epidemiology of community-acquired pneumonia among hospitalised children in Indonesia: a multicentre, prospective study
  1. Dewi Lokida1,
  2. Helmia Farida2,
  3. Rina Triasih3,
  4. Yan Mardian4,
  5. Herman Kosasih4,
  6. Adhella Menur Naysilla4,
  7. Arif Budiman1,
  8. Chakrawati Hayuningsih1,
  9. Moh Syarofil Anam2,
  10. Dwi Wastoro2,
  11. Mujahidah Mujahidah3,
  12. Setya Dipayana2,
  13. Amalia Setyati3,
  14. Abu Tholib Aman3,
  15. Nurhayati Lukman4,
  16. Muhammad Karyana5,
  17. Ahnika Kline6,
  18. Aaron Neal6,
  19. Chuen-Yen Lau7,
  20. Clifford Lane6
  1. 1Tangerang District General Hospital, Tangerang, Banten, Indonesia
  2. 2Rumah Sakit Umum Pusat Dr Kariadi, Semarang, Central Java, Indonesia
  3. 3Rumah Sakit Umum Pusat Dr Sardjito, Sleman, DIY, Indonesia
  4. 4Indonesia Research Partnership on Infectious Disease, Jakarta, Indonesia
  5. 5National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
  6. 6National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
  7. 7National Cancer Institute, Bethesda, Maryland, USA
  1. Correspondence to Dr Yan Mardian; ymardian{at}ina-respond.net

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 outcome(s) measure(s) 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

  • epidemiology
  • infectious diseases
  • paediatrics

Data availability statement

Data are available on reasonable request. Data are available on reasonable request. The anonymised data set will be shared following the signing of a data-sharing agreement, with permission of the ethical clearance committee, study authors and all project partners, exclusively for non-commercial purposes. Please contact the corresponding author with any queries.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

Data are available on reasonable request. Data are available on reasonable request. The anonymised data set will be shared following the signing of a data-sharing agreement, with permission of the ethical clearance committee, study authors and all project partners, exclusively for non-commercial purposes. Please contact the corresponding author with any queries.

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Footnotes

  • Twitter @yan_mardian

  • Contributors DL, HF, RT, YM, HK, AMN, ATA, C-YL and CL designed and conceptualised the study. DL, HF, RT, AB, CH, MSA, DW, MM, SD and AS performed clinical assessments and were responsible for data entry. DL, HF, RT, YM, HK, AMN, NL, AK and C-YL designed the methodology for pathogen identification. YM, HK and AMN performed data analysis, interpretation and drafted the first manuscript. DL, HK, ATA, MK, AN, C-YL and CL assisted with manuscript writing, analysis and interpretation of data. All authors contributed to manuscript development, edited for critical conten and have approved the final version. HK acts as guarantor for the final manuscript.

  • Funding This manuscript has been funded in whole or in part with MoH Indonesia, National Academy of Sciences (Sub-Grant Number: 2000007599), and Federal funds from the NIAID, NIH, under contract Nos. HHSN261200800001E and HHSN261201500003I.

  • Disclaimer The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organisations imply endorsement by the U.S. Government.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.