Etiology of Community-Acquired Pneumonia Requiring Hospitalization in Children

February 25, 2015

Etiology of Community-Acquired Pneumonia Requiring Hospitalization in Children

  1. Deborah Lehman, MD

In a surveillance study, viruses were the predominant pathogens, and most patients were younger than 5 years.

  1. Deborah Lehman, MD

To determine the incidence and etiologies of pediatric community-acquired pneumonia requiring hospitalization since the introduction of vaccines for Haemophilus influenzae type b and Streptococcus pneumoniae, the Centers for Disease Control conducted an active-surveillance study. From 2010 to 2012, 2358 children (<18 years) with radiographic evidence of pneumonia were enrolled at children's hospitals in three cities. Extensive testing for pathogens was performed, including polymerase chain reaction assays for viruses in respiratory swab specimens, serologic testing for viruses, and multiple blood and pleural fluid (when available) tests for bacteria.

Most patients (70%) were younger than 5 years and had at least one underlying condition, such as asthma (33%) or prematurity (21%). A pathogen was isolated in 81% of patients: viruses in 66%, bacteria in 8%, and both in 7%. Respiratory syncytial virus (28%) and rhinovirus (27%) were the most commonly detected viruses, followed by human metapneumovirus (13%), adenovirus (11%), and parainfluenza and influenza viruses (both 7%). Mycoplasma pneumoniae was identified in 8% of children (more commonly in those aged 5 and older), Streptococcus pneumoniae in 4%, and Staphylococcus aureus in 1%. Only 30% of eligible children had received influenza vaccine; 87% of children aged 19 months to 12 years had received at least three doses of pneumococcal conjugate vaccine. Hospital stays were short (median length, 3 days), however, 21% of children required intensive care, 7% were intubated, and 3 (<1%) died. The estimated annual incidence of hospitalization for pneumonia was 15.7 cases per 10,000 children.


This surveillance study provides extensive information about the causes of community-acquired pneumonia in children. Viruses were overwhelmingly implicated, yet 88% of children received antibiotics. Aggressive efforts and improved diagnostics to identify viral etiologies in children with pneumonia will curb unnecessary antibiotic use.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Nothing to disclose


Reader Comments (3)

Deborah Lehman, MD Physician, Pediatrics/Adolescent Medicine, Summary Author / David Geffen School of Medicine at UCLA

You are correct that differentiating a viral from a bacterial is not always easy and has been the focus of many a study!
Improving methodologies for early and accurate detection of viral infection (influenza, adenovirus and many other respiratory viruses) will certainly help to reduce unnecessary antibiotic use for pediatric respiratory infections.

Nuzhat nisar Physician, Pediatrics/Adolescent Medicine, Office based

It would be helpful to know what clinical s/s or othEr markers help distinguish bacterial versus viral

HLALELE ELIAS Physician, Family Medicine/General Practice, South Africa

Although studies and trials have proven beyond doubt that viruses are the most common aetiology for CAP in children and the use of antibiotic is unwarranted, it is not simple to translate this into clinical practice.One cannot distinguish symptoms & signs caused by virus or bacterium on clinical grounds alone as biomarker tests are not immediately available.Fever has been dubbed an ominous sign of infection by our medical teaching.Hence one is likely to admit and treat a feverish child with antibiotics for fear of misdiagnosing a rare but potentially lethal bacterial infection.I've come across many clinical situations whereby even paediatricians themselves advocating non-use of antibiotics doing the opposite when faced with real-life situations.

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