Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022
Document Type
Article
Publication Date
11-1-2024
Abstract
OBJECTIVES:Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN). DESIGN:Prospective multicenter observational study from June 2020 to September 2022. SETTING:Fifteen PICUs in PACCMAN. PATIENTS:All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4-3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 8.4%]) followed by Pseudomonas species (60/846 7.1%]). Second-generation cephalosporins (322/846 38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio aOR], 1.08; 95% CI, 1.00-1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02-1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24-6.00) were associated with greater odds of mortality. CONCLUSIONS:In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.
Keywords
children, epidemiologic research, pneumonia, respiratory infections
Divisions
ummc
Funders
SingHealth (AM/TP003/2018),Pediatric Academic Clinical Programme/Nurturing Clinician Scientist Scheme,National Medical Research Council, Singapore (FLWP20nov_0002)
Publication Title
Pediatric Critical Care Medicine
Volume
25
Issue
11
Publisher
Lippincott, Williams & Wilkins
Publisher Location
TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, PA 19103 USA