PURPOSE: Understanding changes in pathogen and pneumonia prevalence among pediatric pneumonia patients is important for the prevention of infectious diseases. METHODS: We retrospectively analyzed data of children younger than 18 years diagnosed with pneumonia at 117 Emergency Departments in Korea between 2007 and 2014. RESULTS: Over the study period, 329,380 pediatric cases of pneumonia were identified. The most frequent age group was 1–3 years old (48.6%) and the next was less than 12 months of age (17.4%). Based on International Classification of Diseases, 10th revision diagnostic codes, confirmed cases of viral pneumonia comprised 8.4% of all cases, pneumonia due to Mycoplasma pneumoniae comprised 3.8% and confirmed cases of bacterial pneumonia 1.3%. The prevalence of confirmed bacterial pneumonia decreased from 3.07% in 2007 and 4.01% in 2008 to 0.65% in 2014. The yearly rate of pneumococcal pneumonia also decreased from 0.47% in 2007 to 0.08% in 2014. A periodic prevalence of M. pneumoniae pneumonia (MP) was identified. CONCLUSION: The increased number of patients with pneumonia, bacterial pneumonia, pleural effusion, and empyema in 2011 and 2013–2014 resulted from an MP epidemic. We provide evidence that the frequency of confirmed cases of bacterial pneumonia and pneumococcal pneumonia has declined from 2007 to 2014, which can simultaneously reflect the effectiveness of the pneumococcal conjugate vaccine.
Child ; Communicable Diseases ; Community-Acquired Infections ; Emergencies* ; Emergency Service, Hospital* ; Empyema ; Humans ; Information Systems* ; International Classification of Diseases ; Interrupted Time Series Analysis ; Korea* ; Mycoplasma pneumoniae ; Pleural Effusion ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma ; Pneumonia, Pneumococcal ; Pneumonia, Viral ; Prevalence* ; Retrospective Studies

BACKGROUND: Bacterial pneumonia occurring after respiratory viral infection is common. However, the predominant bacterial species causing pneumonia secondary to respiratory viral infections other than influenza remain unknown. The purpose of this study was to know whether the pathogens causing post-viral bacterial pneumonia vary according to the type of respiratory virus. METHODS: Study subjects were 5,298 patients, who underwent multiplex real-time polymerase chain reaction for simultaneous detection of respiratory viruses, among who visited the emergency department or outpatient clinic with respiratory symptoms at Ulsan University Hospital between April 2013 and March 2016. The patients' medical records were retrospectively reviewed. RESULTS: A total of 251 clinically significant bacteria were identified in 233 patients with post-viral bacterial pneumonia. Mycoplasma pneumoniae was the most frequent bacterium in patients aged <16 years, regardless of the preceding virus type (p=0.630). In patients aged ≥16 years, the isolated bacteria varied according to the preceding virus type. The major results were as follows (p<0.001): pneumonia in patients with influenza virus (type A/B), rhinovirus, and human metapneumovirus infections was caused by similar bacteria, and the findings indicated that Staphylococcus aureus pneumonia was very common in these patients. In contrast, coronavirus, parainfluenza virus, and respiratory syncytial virus infections were associated with pneumonia caused by gram-negative bacteria. CONCLUSION: The pathogens causing post-viral bacterial pneumonia vary according to the type of preceding respiratory virus. This information could help in selecting empirical antibiotics in patients with post-viral pneumonia.
Ambulatory Care Facilities ; Anti-Bacterial Agents ; Bacteria ; Coronavirus ; Emergency Service, Hospital ; Gram-Negative Bacteria ; Humans ; Influenza, Human ; Medical Records ; Metapneumovirus ; Mycoplasma pneumoniae ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Pneumonia, Bacterial ; Pneumonia, Mycoplasma ; Pneumonia, Staphylococcal ; Real-Time Polymerase Chain Reaction ; Respiratory Syncytial Virus Infections ; Retrospective Studies ; Rhinovirus ; Ulsan

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of infectious diseases and mortality. CAP is primarily treated by administration of adequate antibiotics against the causative pathogens. Because detection of some pathogens by the conventional culture method is difficult, the use of molecular diagnostic methods is increasing. Although an optimal specimen type is very important for proper testing, there is no consensus on the optimal specimen type for detecting CAP pathogens. In this study, we compared sputum specimens and nasopharyngeal aspirates (NPAs) for molecular detection of 4 CAP-causing bacterial species. METHODS: From September 2011 to January 2012, we collected sputum specimens and NPAs from CAP patients on the first or second day of hospitalization. The specimens were tested for Mycoplasma pneumoniae, Streptococcus pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila by using commercial real-time PCR. RESULTS: We collected 63 sputum specimens and 96 NPAs from 109 patients and found positive results for 38.1% (24/63) and 28.1% (27/96), respectively (P = 0.251). There were no significant differences in the positive rates obtained for sputum specimens of different quality. CONCLUSIONS: The results obtained using NPAs and sputum specimens for the molecular detection of CAP pathogens were comparable.
Anti-Bacterial Agents ; Chlamydial Pneumonia ; Chlamydophila pneumoniae ; Communicable Diseases ; Consensus ; Hospitalization ; Humans ; Legionella pneumophila ; Mycoplasma pneumoniae ; Pathology, Molecular ; Pneumonia ; Pneumonia, Mycoplasma ; Real-Time Polymerase Chain Reaction ; Sputum ; Streptococcus pneumoniae

PURPOSE: Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, epidemiological studies for HCAP in South Korea are limited. This study aimed to reveal the differences between HCAP and community-acquired pneumonia (CAP), especially in elderly patients, in university-affiliated hospital in South Korea. MATERIALS AND METHODS: We conducted a retrospective observational study of patients with HCAP and CAP (older than 60 years old) who were hospitalized between January 2007 and December 2008. We compared the baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics, and clinical outcomes. RESULTS: A total of 210 patients were evaluated, including 35 patients with HCAP (17%) and 175 with CAP (83%). The most common causative organism was Streptococcus pneumoniae in CAP (33.3%), whereas, Staphylococcus aureus was most common pathogen in HCAP (40.0%). Initial inappropriate antibiotics (6.3% vs. 22.9%; p < 0.005) and initial treatment failure (15.4% vs. 31.4%; p = 0.018) were more frequent in HCAP than CAP. However, mortality (11.4% vs. 5.7%; p = 0.369) was not different between the two groups. CONCLUSION: The present study provides additional evidence that HCAP should be distinguished from CAP, even in elderly patients, in South Korea. Physicians should consider S. aureus and MDR pathogens in selecting initial empirical antibiotics of HCAP in South Korea.
Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/*diagnosis/drug therapy/microbiology ; Cross Infection/*diagnosis/drug therapy/microbiology ; Female ; Hospitals, University ; Humans ; Male ; Middle Aged ; Pneumonia, Bacterial/*diagnosis/drug therapy/microbiology ; Pneumonia, Pneumococcal/diagnosis/drug therapy ; Pneumonia, Staphylococcal/diagnosis/drug therapy ; Republic of Korea ; Treatment Outcome

Mycoplasma pneumoniae is a common cause of community-acquired respiratory infection in children. Through uncertain pathologic mechanisms, which most probably involve immunologically cell-mediated tissue damage, it causes life-threatening disease on rare occasion. We herein report a case of M. pneumoniae pneumonia, with encephalopathy followed by multiple organ failure in a previously healthy boy. Despite of intensive therapies with intravenous antibiotics, corticosteroid, hemodiafiltration, and transfusion, his neurologic and pulmonary sequales have remained. In most cases M. pneumoniae pneumonia are usually self- limiting with benign outcome. Even in healthy individual, however, it can manifest itself with a fulminant course and multi organ failure.
Anti-Bacterial Agents ; Child ; Hemodiafiltration ; Humans ; Multiple Organ Failure ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma

The role of atypical bacterial infection in the pathogenesis of asthma is a subject of continuing debate. There is an increasing body of literature concerning the association between the atypical bacteria such as Mycoplasma pneumoniae (M. pneumoniae) and asthma pathogenesis. Moreover, many studies investigating such a link have been uncontrolled and have provided conflicting evidence, in part due to the difficulty in accurately diagnosing infection with these atypical pathogens. This manuscript will review the relationship between M. pneumoniae infection and asthma pathogenesis.
Aluminum Hydroxide ; Asthma ; Bacteria ; Bacterial Infections ; Carbonates ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma

Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation.
Anti-Bacterial Agents ; Child ; Diagnosis ; Hospitalization ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Young Adult

Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation.
Anti-Bacterial Agents ; Child ; Diagnosis ; Hospitalization ; Humans ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Young Adult

No abstract available.
Adrenal Cortex Hormones* ; Anti-Bacterial Agents* ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma*

Pneumonia remains the leading cause of mortality in children. Diagnosis depends on a combination of factors, including clinical assessment, radiological and laboratory findings. Although Streptococcus pneumoniae remains the most important cause of childhood bacterial pneumonia, the great majority of cases of community-acquired pneumonia (CAP) are of viral etiology. A new, rapid, and inexpensive test that differentiates viral from bacterial pneumonia is needed to decide empiric antibiotic treatment. Antibiotics effective against the expected bacterial pathogens should be instituted where necessary. The role of emerging pathogens and the effect of pneumococcal resistance and heptavalent conjugate pneumococcal vaccines are to be considered in practice. There are reports supporting the valid and highly efficacious use of penicillin as a first-line drug for treating CAP. This review raises the issue of the overuse of unnecessary antibiotics in viral CAPs and the use of second or third-line antibiotics for non-complicated pneumonias in most clinical settings.
Anti-Bacterial Agents ; Child ; Humans ; Penicillins ; Pneumococcal Vaccines ; Pneumonia ; Pneumonia, Bacterial ; Streptococcus pneumoniae