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

Wong JJM 1 , Abbas Q 2 , Wang JQY 3 , Xu W 4 , Dang H 5 , Phan PH 6 Show all authors , Guo L 7 , Lee PC 8 , Zhu X 9 , Angurana SK 10 , Pukdeetraipop M 11 , Efar P 12 , Yuliarto S 13 , Choi I 14 , Fan L 15 , Hui AWF 16 , Gan CS 3 , Liu C 4 , Samransamruajkit R 11 , Cho HJ 14 , Ong JSM 15 , Lee JH 10 , Pediatric Acute and Critical Care Asian Network (PACCMAN)

Affiliations 

  • 1 Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
  • 2 Aga Khan University Hospital, Karachi, Pakistan
  • 3 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 4 Shengjing Hospital of China Medical University, Shenyang, China
  • 5 Children's Hospital of Chongqing Medical University, Chongqing, China
  • 6 National Children's Hospital, Hanoi, Vietnam
  • 7 Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore
  • 8 Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 9 Children's Hospital of Fudan University, Shanghai, China
  • 10 Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 11 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 12 Harapan Kita National Women and Children Health Center, Jakarta, Indonesia
  • 13 Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia
  • 14 Chonnam National University Children's Hospital, Gwangju, South Korea
  • 15 National University Hospital, Singapore
  • 16 Hong Kong Children's Hospital, Hong Kong SAR, China
Pediatr Crit Care Med, 2024 Nov 01;25(11):1035-1044.
PMID: 39177431 DOI: 10.1097/PCC.0000000000003598

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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