title: Epidemiology and microbiological investigations of community-acquired pneumonia in children admitted at the emergency department of a university hospital.
abstract: BACKGROUND
  The management of children with community-acquired pneumonia (CAP) is largely influenced by the development of new molecular diagnostic tests that allow the simultaneous detection of a wide range of pathogens.
  
  
  OBJECTIVE
  Evaluation of a diagnostic approach including multiplex PCR assays for revisiting the epidemiology and etiology of CAP in children at hospital.
  
  
  METHODS
  Children of all ages consulting at the Emergency Department of the University hospital of Saint-Etienne, France, during the 2012-2013 winter period were included. In addition to bacterial cultures, the following pathogens were detected using biplex commercially-available rt-PCR tests: adenovirus, respiratory syncytial virus, human metapneumovirus, bocavirus, rhinovirus/enterovirus, coronavirus, influenza viruses A and B, parainfluenza viruses, Mycoplasma pneumoniae and Chlamydophila pneumonia.
  
  
  RESULTS
  From 85 patients with CAP, at least one pathogen was identified in 81 cases (95.3%), including 4 bacterial exclusive infections (4.7%), 53 viral exclusive infections (62.4%) and 24 mixed infections (28.2%). Coinfection by at least two viruses was observed in 37 cases (43.5%). Mean age was higher in the case of documented bacterial infection (P<0.05). In the subgroup of viral exclusive infection, the mean age of severe cases was 2.0 years vs 3.8 years in mild and moderate cases (P<0.05).
  
  
  CONCLUSIONS
  These findings highlight the huge proportion of CAP of viral origin, the high number of co-infection by multiple viruses and the low number of bacterial CAP, notably in children under 5 years, and address the need to re-evaluate the indications of empiric antimicrobial treatment in this age group.
authors.affiliation: Department of Pediatric Emergency, University-Hospital of Saint-Etienne, CHU de Saint-Etienne, 42055 Saint-Etienne Cedex 02, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Cantais
authors.affiliation: Department of Pediatric Emergency, University-Hospital of Saint-Etienne, CHU de Saint-Etienne, 42055 Saint-Etienne Cedex 02, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mory
authors.affiliation: Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Pillet
authors.affiliation: Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France.
authors.forename: Paul O
authors.initials: PO
authors.lastname: Verhoeven
authors.affiliation: Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Bonneau
authors.affiliation: Pediatric Intensive Care Unit, University-Hospital of Saint-Etienne, CHU de Saint Etienne, 42055 Saint-Etienne Cedex 02, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Patural
authors.affiliation: Groupe Immunité des Muqueuses et Agents Pathogènes, EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 42023 Saint-Etienne Cedex 02, France. Electronic address: bruno.pozzetto@univ-st-etienne.fr.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pozzetto
mesh_terms: D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D025202:Molecular Diagnostic Techniques; D060885:Multiplex Polymerase Chain Reaction; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D011024:Pneumonia, Viral / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: Children; Community-acquired-pneumonia; Epidemiology; PCR; Viral pneumonia