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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.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: 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
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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.
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