Aetiology of community-acquired pneumonia among infants and children at a hospital in Vietnam: screening for multiple pathogens using molecular methods

Objective: To investigate potential respiratory pathogens in children with community-acquired pneumonia (CAP) and risk factors for severe disease in a Vietnamese hospital. Methods: : Clinical data and laboratory results were collected. Twenty-four respiratory pathogens were tested from nasopharyngeal swabs using real-time PCR. Results: : 467 children with CAP were included, mean age = 15.4±13.3 months, 63.0% were male. Over 97% of patients had a positive PCR result. Majority of patients (87%) were positive for multiple (up to eight) pathogens. Rhinovirus (46%), respiratory syncytial virus (RSV) (24%), enterovirus (17%), and parainfluenza viruses-3 (13%) were the most frequent viruses. H. influenzae (61%), S. pneumoniae (45%) and M. catarrhalis (30%) were the most common bacteria. 128 (27 %) cases were classified as severe pneumonia. Presence of smokers at home, CRP level ≥ 50 mg/dL, RSV and H. influenzae PCR detection associated with a higher risk of severe pneumonia (aOR=2.11, P value=0.004; aOR=6.11, P value<0.0001; aOR=1.78, P value=0.03 and aOR=1.66, P value=0.04, respectively). Conclusion: Causative agents of pneumonia in children are complex. Case-controlled and metagenomic studies need to be performed to further investigate the role of the presence of microbial agents in the respiratory tract on pneumonia in children to differentiate between colonisation and infection.