Effect of age, polymicrobial disease,, and maternal HIV status on treatment response and cause of severe pneumonia in South African children: a prospective descriptive study

被引:208
作者
McNally, Lisa M.
Jeena, Prakash M.
Gajee, Kovitha
Thula, Stanley A.
Sturm, A. Willem
Cassol, Sharon
Tomkins, Andrew M.
Coovadia, Hoosen M.
Goldblatt, David
机构
[1] UCL, Inst Child Hlth, Ctr Int Child Hlth & Dev, London WC1N 1EH, England
[2] UCL, Inst Child Hlth, Immunobiol Unit, London WC1N 1EH, England
[3] Univ KwaZulu Natal, Nelson R Mandela Sch Med, Dept Paediat & Child Hlth, Durban, South Africa
[4] Univ KwaZulu Natal, Nelson R Mandela Sch Med, Dept Med Microbiol, Durban, South Africa
[5] Univ KwaZulu Natal, Nelson R Mandela Sch Med, Doris Duke Med Res Inst, Durban, South Africa
[6] Univ Pretoria, Fac Hlth Sci, Dept Immunol, MRC,Unit Inflammat & Immun, ZA-0002 Pretoria, South Africa
基金
英国惠康基金;
关键词
D O I
10.1016/S0140-6736(07)60670-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background HIV-related pneumonia is the main cause of paediatric hospital admissions in southern Africa. We aimed to measure predictors of treatment failure and the cause of non-responsive pneumonia in children admitted to hospital with severe pneumonia in Durban, South Africa. Methods We investigated 358 children aged 1-59 months who presented with WHO-defined severe or very severe pneumonia. Children were recruited irrespective of HIV status and started on a standard antimicrobial regimen of benzylpenicillin and gentamicin. All infants also received high-dose trimethoprim-sulfamethoxazole. The primary outcome measure was treatment failure at 48 h. Findings 242 (68%) children were HIV infected, 41 (12%) HIV exposed, unindected, and 75 (21%) HIV uninfected. Failure to respond by 48 h was predicted by age under 1 year (adjusted odds ratio 6.38, 95% CI 2.72-14.91, p < 0.0001), very severe disease (2.47, 1.17-5.24, p=0.0181), HIV status (HIV infected 10.3, 3.26-32.51; HIV exposed, uninfected 6.02, 1.55-23.38; p=0.0003), and polymicrobial disease (one organism 2.06, 1.05-4.05; two organisms 10.75, 4.38-26.36; p < 0.0001) on logistic regression analysis. All children with three organisms failed treatment. 72/110 treatment failures had at least two organisms isolated. Three of nine HIV-exposed, uninfected infants, 29/74 HIV-infected, but no HIV-uninfected infants who failed study therapy had Pneumocystis jirovecii pneumonia. Interpretation For children younger than 1 year, the WHO guidelines are inadequate and need to be revised since both HIV-infected and HIV-exposed, uninfected infants had more treatment failures than did HIV-uninfected infants. Polymicrobial disease is an important reason for treatment failure, and we need to identify rapid low-cost diagnostic methods to assist clinicians.
引用
收藏
页码:1440 / 1451
页数:12
相关论文
共 43 条
[1]   Oral amoxicillin versus injectable penicillin for severe pneumonia in children aged 3 to 59 months: a randomised multicentre equivalency study [J].
Addo-Yobo, E ;
Chisaka, N ;
Hassan, M ;
Hibberd, P ;
Lozano, JM ;
Jeena, P ;
MacLeod, WB ;
Maulen, I ;
Patel, A ;
Qazi, S ;
Thea, DM ;
Nguyen, NTV .
LANCET, 2004, 364 (9440) :1141-1148
[2]   THE ETIOLOGY OF PNEUMONIA IN MALNOURISHED AND WELL-NOURISHED GAMBIAN CHILDREN [J].
ADEGBOLA, RA ;
FALADE, AG ;
SAM, BE ;
AIDOO, M ;
BALDEH, I ;
HAZLETT, D ;
WHITTLE, H ;
GREENWOOD, BM ;
MULHOLLAND, EK .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1994, 13 (11) :975-982
[3]  
AMAROGALVEZ R, 1991, PEDIATR INFECT DIS J, V10, P473, DOI 10.1097/00006454-199106000-00015
[4]   WHO estimates of the causes of death in children [J].
Bryce, J ;
Boschi-Pinto, C ;
Shibuya, K ;
Black, RE .
LANCET, 2005, 365 (9465) :1147-1152
[5]   How safe is non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated children? [J].
Burmester, M ;
Mok, Q .
INTENSIVE CARE MEDICINE, 2001, 27 (04) :716-721
[6]   Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study [J].
Chintu, C ;
Mudenda, V ;
Lucas, S ;
Nunn, A ;
Lishimpi, K ;
Maswahu, D ;
Kasolo, F ;
Mwaba, P ;
Bhat, G ;
Terunuma, H ;
Zumla, A .
LANCET, 2002, 360 (9338) :985-990
[7]   T-lymphocyte maturation abnormalities in uninfected newborns and children with vertical exposure to HIV [J].
Clerici, M ;
Saresella, M ;
Colombo, F ;
Fossati, S ;
Sala, N ;
Bricalli, D ;
Villa, ML ;
Ferrante, P ;
Dally, L ;
Vigano, A .
BLOOD, 2000, 96 (12) :3866-3871
[8]  
Delport SD, 2002, SAMJ S AFR MED J, V92, P907
[9]  
deMoraesPinto MI, 1996, J INFECT DIS, V173, P1077, DOI 10.1093/infdis/173.5.1077
[10]   Chloramphenicol versus benzylpenicillin and gentamicin for the treatment of severe pneumonia in children in Papua New Guinea: a randomised trial [J].
Duke, T ;
Poka, H ;
Dale, F ;
Michael, A ;
Mgone, J ;
Wal, T .
LANCET, 2002, 359 (9305) :474-480