Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia
BackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epide...
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1140100/full |
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| author | Helmia Farida Rina Triasih Dewi Lokida Yan Mardian Gustiani Salim Wahyu Nawang Wulan Deni P. Butar-butar Rizki Amalia Sari Arif Budiman Chakrawati Hayuningsih Moh Syarofil Anam Setya Dipayana Mujahidah Mujahidah Amalia Setyati Abu Tholib Aman Adhella Menur Naysilla Nurhayati Lukman Aly Diana Muhammad Karyana Ahnika Kline Aaron Neal H. Clifford Lane Herman Kosasih Chuen-Yen Lau |
| author_facet | Helmia Farida Rina Triasih Dewi Lokida Yan Mardian Gustiani Salim Wahyu Nawang Wulan Deni P. Butar-butar Rizki Amalia Sari Arif Budiman Chakrawati Hayuningsih Moh Syarofil Anam Setya Dipayana Mujahidah Mujahidah Amalia Setyati Abu Tholib Aman Adhella Menur Naysilla Nurhayati Lukman Aly Diana Muhammad Karyana Ahnika Kline Aaron Neal H. Clifford Lane Herman Kosasih Chuen-Yen Lau |
| author_sort | Helmia Farida |
| collection | DOAJ |
| description | BackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP.MethodsData from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression.ResultsDiarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia’s rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08–0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18–18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07–25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively.ConclusionCombining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model. |
| first_indexed | 2024-03-13T10:33:57Z |
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| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-13T10:33:57Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-51df1ac532b2409db380fc39565357172023-05-18T07:59:36ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-05-011010.3389/fmed.2023.11401001140100Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumoniaHelmia Farida0Rina Triasih1Dewi Lokida2Yan Mardian3Gustiani Salim4Wahyu Nawang Wulan5Deni P. Butar-butar6Rizki Amalia Sari7Arif Budiman8Chakrawati Hayuningsih9Moh Syarofil Anam10Setya Dipayana11Mujahidah Mujahidah12Amalia Setyati13Abu Tholib Aman14Adhella Menur Naysilla15Nurhayati Lukman16Aly Diana17Muhammad Karyana18Ahnika Kline19Aaron Neal20H. Clifford Lane21Herman Kosasih22Chuen-Yen Lau23Rumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, IndonesiaRumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, IndonesiaTangerang District General Hospital, Tangerang, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaTangerang District General Hospital, Tangerang, IndonesiaTangerang District General Hospital, Tangerang, IndonesiaRumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, IndonesiaRumah Sakit Umum Pusat Dr. Kariadi Hospital/Diponegoro University, Semarang, IndonesiaRumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, IndonesiaRumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, IndonesiaRumah Sakit Umum Pusat Dr. Sardjito Hospital/Universitas Gadjah Mada, Yogyakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaNational Institute of Health Research and Development, Ministry of Health Republic of Indonesia, Jakarta, IndonesiaNational Institute of Allergy and Infectious Diseases, Bethesda, MD, United StatesNational Institute of Allergy and Infectious Diseases, Bethesda, MD, United StatesNational Institute of Allergy and Infectious Diseases, Bethesda, MD, United StatesIndonesia Research Partnership on Infectious Disease, Jakarta, IndonesiaNational Cancer Institute, Bethesda, MD, United StatesBackgroundDiscrimination of bacterial and viral etiologies of childhood community-acquired pneumonia (CAP) is often challenging. Unnecessary antibiotic administration exposes patients to undue risks and may engender antimicrobial resistance. This study aimed to develop a prediction model using epidemiological, clinical and laboratory data to differentiate between bacterial and viral CAP.MethodsData from 155 children with confirmed bacterial or mixed bacterial and viral infection (N = 124) and viral infection (N = 31) were derived from a comprehensive assessment of causative pathogens [Partnerships for Enhanced Engagement in Research-Pneumonia in Pediatrics (PEER-PePPeS)] conducted in Indonesia. Epidemiologic, clinical and biomarker profiles (hematology and inflammatory markers) were compared between groups. The area under the receiver operating characteristic curve (AUROC) for varying biomarker levels was used to characterize performance and determine cut-off values for discrimination of bacterial and mixed CAP versus viral CAP. Diagnostic predictors of bacterial and mixed CAP were assessed by multivariate logistic regression.ResultsDiarrhea was more frequently reported in bacterial and mixed CAP, while viral infections more frequently occurred during Indonesia’s rainy season. White blood cell counts (WBC), absolute neutrophil counts (ANC), neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were significantly higher in bacterial and mixed cases. After adjusting for covariates, the following were the most important predictors of bacterial or mixed CAP: rainy season (aOR 0.26; 95% CI 0.08–0.90; p = 0.033), CRP ≥5.70 mg/L (aOR 4.71; 95% CI 1.18–18.74; p = 0.028), and presence of fever (aOR 5.26; 95% CI 1.07–25.91; p = 0.041). The model assessed had a low R-squared (Nagelkerke R2 = 0.490) but good calibration (p = 0.610 for Hosmer Lemeshow test). The combination of CRP and fever had moderate predictive value with sensitivity and specificity of 62.28 and 65.52%, respectively.ConclusionCombining clinical and laboratory profiles is potentially valuable for discriminating bacterial and mixed from viral pediatric CAP and may guide antibiotic use. Further studies with a larger sample size should be performed to validate this model.https://www.frontiersin.org/articles/10.3389/fmed.2023.1140100/fullpediatriccommunity acquired pneumoniabacterialviralperformance characteristics |
| spellingShingle | Helmia Farida Rina Triasih Dewi Lokida Yan Mardian Gustiani Salim Wahyu Nawang Wulan Deni P. Butar-butar Rizki Amalia Sari Arif Budiman Chakrawati Hayuningsih Moh Syarofil Anam Setya Dipayana Mujahidah Mujahidah Amalia Setyati Abu Tholib Aman Adhella Menur Naysilla Nurhayati Lukman Aly Diana Muhammad Karyana Ahnika Kline Aaron Neal H. Clifford Lane Herman Kosasih Chuen-Yen Lau Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia Frontiers in Medicine pediatric community acquired pneumonia bacterial viral performance characteristics |
| title | Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| title_full | Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| title_fullStr | Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| title_full_unstemmed | Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| title_short | Epidemiologic, clinical, and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| title_sort | epidemiologic clinical and serum markers may improve discrimination between bacterial and viral etiologies of childhood pneumonia |
| topic | pediatric community acquired pneumonia bacterial viral performance characteristics |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1140100/full |
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