美国儿童中需要住院治疗的社区获得性肺炎。
Community-acquired pneumonia requiring hospitalization among U.S. children.
作者信息
Jain Seema, Williams Derek J, Arnold Sandra R, Ampofo Krow, Bramley Anna M, Reed Carrie, Stockmann Chris, Anderson Evan J, Grijalva Carlos G, Self Wesley H, Zhu Yuwei, Patel Anami, Hymas Weston, Chappell James D, Kaufman Robert A, Kan J Herman, Dansie David, Lenny Noel, Hillyard David R, Haynes Lia M, Levine Min, Lindstrom Stephen, Winchell Jonas M, Katz Jacqueline M, Erdman Dean, Schneider Eileen, Hicks Lauri A, Wunderink Richard G, Edwards Kathryn M, Pavia Andrew T, McCullers Jonathan A, Finelli Lyn
机构信息
From the Centers for Disease Control and Prevention, Atlanta (S.J., A.M.B., C.R., L.M.H., M.L., S.L., J.M.W., J.M.K., D.E., E.S., L.A.H., L.F.); Vanderbilt University School of Medicine (D.J.W., C.G.G., W.H.S., Y.Z., J.D.C., J.H.K., K.M.E.), Monroe Carell Jr. Children's Hospital at Vanderbilt (D.J.W., K.M.E.), and Vanderbilt Vaccine Research Program (D.J.W., K.M.E.), Nashville, and Le Bonheur Children's Hospital (S.R.A., A.P., N.L., J.A.M.), University of Tennessee Health Science Center (S.R.A., A.P., R.A.K., N.L., J.A.M.), and St. Jude Children's Research Hospital (R.A.K., J.A.M.), Memphis - all in Tennessee; University of Utah Health Sciences Center, Salt Lake City (K.A., C.S., W.H., D.D., D.R.H., A.T.P.); and Northwestern University Feinberg School of Medicine, Chicago (E.J.A., R.G.W.).
出版信息
N Engl J Med. 2015 Feb 26;372(9):835-45. doi: 10.1056/NEJMoa1405870.
BACKGROUND
Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed.
METHODS
We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists.
RESULTS
From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%).
CONCLUSIONS
The burden of hospitalization for children with community-acquired pneumonia was highest among the very young, with respiratory viruses the most commonly detected causes of pneumonia. (Funded by the Influenza Division of the National Center for Immunization and Respiratory Diseases.).
背景
基于前瞻性数据收集的美国儿童社区获得性肺炎住院发病率估计有限。需要对经影像学证实并使用当前实验室诊断检测的肺炎进行更新估计。
方法
我们在孟菲斯、纳什维尔和盐湖城的三家医院对18岁以下需要住院治疗的社区获得性肺炎儿童进行了基于人群的主动监测。我们排除了近期住院或严重免疫抑制的儿童。系统收集血液和呼吸道标本，使用多种方法进行病原体检测。胸部X光片由研究放射科医生独立审查。
结果
从2010年1月到2012年6月，我们纳入了3803名符合条件儿童中的2638名（69%），其中2358名（89%）有肺炎的影像学证据。儿童的中位年龄为2岁（四分位间距，1至6岁）；2358名儿童中有497名（21%）需要重症监护，3名（<1%）死亡。在2222名有肺炎影像学证据且有标本可进行细菌和病毒检测的儿童中，1802名（81%）检测到病毒或细菌病原体，1472名（66%）检测到一种或多种病毒，175名（8%）检测到细菌，155名（7%）检测到细菌和病毒病原体。肺炎的年发病率为每10000名儿童15.7例（95%置信区间[CI]，14.9至16.5），2岁以下儿童发病率最高（每10000名儿童62.2例；95%CI，57.6至67.1）。呼吸道合胞病毒在5岁以下儿童中比在大龄儿童中更常见（37%对8%），腺病毒（15%对3%）和人偏肺病毒（15%对8%）也是如此。肺炎支原体在5岁及以上儿童中比在年幼儿童中更常见（19%对3%）。
结论
社区获得性肺炎儿童的住院负担在幼儿中最高，呼吸道病毒是最常检测到的肺炎病因。（由国家免疫和呼吸疾病中心流感司资助。）
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