168. Etiology of Community-acquired Pneumonia among Hospitalized Children in the United States: Preliminary Data from the CDC Etiology of Pneumonia in the Community (EPIC) Study
Session: Oral Abstract Session: Pediatric Pneumonia
Friday, October 21, 2011: 11:00 AM
Room: 156ABC


Background: Pneumonia is a common cause of pediatric hospitalization.  Over the last two decades, molecular diagnostic methods have improved and community-acquired pneumonia (CAP) etiology has evolved due to antimicrobial use and expanded vaccine use.  The CDC EPIC study aims to determine CAP etiology among hospitalized children.  

Methods: Children <18 years old were enrolled in 3 hospitals in Memphis, Nashville, and Salt Lake City.  A CAP case was defined as an acute infection with respiratory symptoms, and new radiographic pneumonia in a child from and hospitalized in the catchment area without recent hospitalization.  Blood for culture and streptococcal polymerase chain-reaction (PCR) targeting lyt-A and spy genes and naso/oropharyngeal swabs (NP/OP) for PCR of respiratory viruses and atypical bacteria were collected as soon as possible after admission.

Results: From January-September 2010, we enrolled 548 (68%) of 804 eligible children with CAP aged 0-23 months (50%), 2-4 years (23%), and 5-17 years (27%).  The majority were white (39%), black (31%), or Hispanic (21%).  Seventy-four (15%) of 497 children with available data were admitted to intensive care; there were no deaths.  A viral (76%) or bacterial (8%) pathogen was detected in a total of 504 children with both blood (culture or PCR) and NP/OP results available (Figure 1A & B).  Co-infections were detected in 24% of children (98 cases had ≥1 virus, 21 cases had both bacteria and viruses).  No pathogen was detected in 20% of children.  Antibiotics were prescribed to 25% of 548 children before hospitalization.  Among children with blood sample timing available, 75% of 333 first cultures and 33% of 372 PCR samples were collected before inpatient antibiotic administration.

Conclusion: In this multi-site prospective study, viruses were commonly detected in children with pneumonia.  Bacteria may have been under detected due to antibiotic use and differences in specimen sources used for diagnostic testing.  Additional etiologic testing is underway, including in healthy pediatric controls, which will help elucidate clinical relevance.  The CDC EPIC study is ongoing and will continue to provide insights into pediatric CAP etiology and incidence.   

Subject Category: P. Pediatric and perinatal infections

Seema Jain, MD1, Krow Ampofo, MD2, Sandra R. Arnold, MD3,4, Derek J. Williams, MD, MPH5, Evan Anderson, MD6, Anna M. Bramley, MPH1, Weston Hymas, MS, MB(ASCP)7, Robert A. Kaufman, MD4,8, Wesley H. Self, MD, MPH5, Dean Erdman, DrPH1, Jonas M. Winchell, PhD1, Maria da Gloria Carvalho, PhD1, Stephen Lindstrom, PhD1, James D. Chappell, MD, PhD5, Anami Patel, PhD3,4, David Hillyard, MD7, Carlos Grijalva, MD MPH5, Eileen Schneider, MD, MPH1, Lauri Hicks, DO1, Richard Wunderink, MD6, Kathryn Edwards, MD, FIDSA5, Jonathan A. McCullers, MD8, Andrew Pavia, MD, FIDSA2 and Lyn Finelli, DrPH, MS1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)University of Utah Health Sciences Center, Salt Lake City, UT, (3)Le Bonheur Children's Hospital, Memphis, TN, (4)University of Tennessee Health Science Center, Memphis, TN, (5)Vanderbilt University School of Medicine, Nashville, TN, (6)Nortwestern University Feinberg School of Medicine, Chicago, IL, (7)Associated Regional and University Pathologists, Salt Lake City, UT, (8)St. Jude Children's Research Hospital, Memphis, TN


S. Jain, None

K. Ampofo, None

S. R. Arnold, None

D. J. Williams, None

E. Anderson, Merck: Grant Investigator, Research grant
Medscape: Independent Contractor, Financial support for writing CME.

A. M. Bramley, None

W. Hymas, None

R. A. Kaufman, None

W. H. Self, None

D. Erdman, None

J. M. Winchell, None

M. D. G. Carvalho, None

S. Lindstrom, None

J. D. Chappell, None

A. Patel, None

D. Hillyard, None

C. Grijalva, None

E. Schneider, None

L. Hicks, None

R. Wunderink, None

K. Edwards, None

J. A. McCullers, AVIBioPharma: Consultant, Consulting fee
GlaxoSmithKline: Consultant, Consulting fee
Novartis: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee

A. Pavia, pfizer: Consultant, Consulting fee

L. Finelli, None

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