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Infectious diseases
Original research
Paediatric critical illness associated with respiratory infection: a single-centre, retrospective cohort study
  1. Haifa Alfaraidi1,
  2. Kathy Luinstra2,
  3. Alireza Eshaghi3,
  4. Marek Smieja4,
  5. Jonathan B Gubbay3,5,
  6. Jeffrey M Pernica1
  1. 1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Laboratory Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
  3. 3Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
  4. 4Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  5. 5Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jeffrey M Pernica; pernica{at}mcmaster.ca

Abstract

Objectives To describe critically ill children with respiratory infections, classify them by infection syndrome type and determine the prevalence of Mycoplasma pneumoniae detection.

Study design A retrospective, single-centre cohort study. All children aged 2 months–18 years with presumed respiratory infection who were admitted to a tertiary hospital paediatric intensive care unit (PICU) between September 2015 and October 2016 were eligible. Subjects were grouped by clinical syndrome (viral respiratory infection, asthma exacerbation, undifferentiated/uncomplicated pneumonia, pneumonia complicated by effusion/empyema and ‘other’). All subjects had nasopharyngeal swabs tested for respiratory viruses, M. pneumoniae and Chlamydia pneumoniae.

Results There were 221 subjects; the median age was 3.1 years; 44% were female; and 78% had medical comorbidities. The majority (75%) was treated with antibiotics, most often ceftriaxone (90% of treated children). Those with any pneumonia were significantly less likely to have a respiratory virus identified in their nasopharynges and had significantly higher C reactive protein (CRP) values than those in the viral infection and asthma groups. There were 10 subjects in whom M. pneumoniae was detected (4.5%, 95% CI 2.2% to 8.2%). Mycoplasma-positive children were older (difference 3.5 years, 95% CI 0.66 to 6.4 years) and had fewer viral coinfections (30% compared with 69%, p=0.02). The prevalence of Mycoplasma infection in children aged >5 years with any pneumonia was 13.2% (95%CI 4.4% to 28%).

Conclusions The majority of participants had respiratory viruses detected and were treated with broad-spectrum antibiotics. Differences in CRP and viral prevalence were observed between children with different infection syndrome types. M. pneumoniae infection was not rare in school-aged children with pneumonia admitted to the PICU. Attention to antibiotic treatment and rapid diagnostic testing for Mycoplasma in older, critically ill children should be considered to optimise management and avert morbidity and mortality from respiratory infection.

  • infectious diseases
  • epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjpo-2020-000640

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    Footnotes

    • Presented at Poster presentation, Association of Medical Microbiology and Infectious Disease Canada Annual Conference, 2018.

    • Contributors HA designed the study, submitted for funding, did the data collection, aided with analysis and played an important role in manuscript writing. JMP conceived the study and played an important role in study design, conduct, analysis and manuscript writing. KL performed microbiological testing and aided with the development of methods. MS and JBG oversaw the microbiological methods and played an important role in study design and manuscript revision. AE performed microbiological testing, aided with the method development and critically revised the manuscript.

    • Funding This project was supported by a McMaster University Department of Pediatrics Resident Research Grant. JMP was supported by a Hamilton Health Sciences Early Career Award.

    • Competing interests No, there are no competing interests.

    • 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.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Hamilton Integrated Research Ethics Board, which waived the requirement for consent in this retrospective study.

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

    • Data availability statement Data are available upon reasonable request.