Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022.

IF 4 2区医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-23 DOI:10.1097/PCC.0000000000003598

Judith Ju Ming Wong, Qalab Abbas, Justin Qi Yuee Wang, Wei Xu, Hongxing Dang, Phuc Huu Phan, Liang Guo, Pei Chuen Lee, Xuemei Zhu, Suresh Kumar Angurana, Minchaya Pukdeetraipop, Pustika Efar, Saptadi Yuliarto, Insu Choi, Lijia Fan, Alvin Wun Fung Hui, Chin Seng Gan, Chunfeng Liu, Rujipat Samransamruajkit, Hwa Jin Cho, Jacqueline Soo May Ong, Jan Hau Lee

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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.

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儿童重症监护病房收治的重症肺炎患者：儿科急重症医学亚洲网络（PACCMAN）观察性队列研究，2020-2022 年。

目标：亚洲的肺炎死亡率是工业化国家的三倍。我们旨在确定亚洲儿科急危重症医学网络（PACCMAN）PICU 重症肺炎的流行病学、微生物学和治疗效果：设计：2020年6月至2022年9月的前瞻性多中心观察研究：地点：PACCMAN 的 15 个 PICU：干预措施：无：测量和主要结果记录临床、微生物学和结果数据。主要结果是 PICU 死亡率。进行了单变量和多变量逻辑回归，以研究 PICU 死亡率与入住 PICU 时的解释性风险因素之间的关联。在接受筛查的 11,778 名 PICU 患者中，有 846 人（7.2%）患有肺炎，中位年龄为 1.2 岁（四分位间范围为 0.4-3.7 岁）。846 例患者中有 111 例（13.1%）检测到呼吸道合胞病毒。最常见的细菌是葡萄球菌（71/846 [8.4%]），其次是假单胞菌（60/846 [7.1%]）。第二代头孢菌素（322/846 [38.1%]）是最常见的广谱抗生素，其次是碳青霉烯类（174/846 [20.6%]）。846 位患者中有 438 位（51.8%）接受了有创机械通气，846 位患者中有 500 位（59.1%）接受了无创呼吸支持。846 例患者中，65 例（7.7%）出现 PICU 死亡率。在多变量逻辑回归模型中，年龄（调整后几率比 [aOR]，1.08；95% CI，1.00-1.16）、儿科死亡率指数 3 评分（aOR，1.03；95% CI，1.02-1.05）和嗜睡（aOR，2.73；95% CI，1.24-6.00）与更高的死亡几率相关：结论：在 PACCMAN 提供数据的 PICU 中，肺炎是入院的常见原因（7%），并与较高的死亡率相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.