681. Severity of pneumonia in under five-year children from developing countries: multicentre prospective observational study
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
Background: The primary objective was to assess the microbiological agents associated with hypoxemic compared to non-hypoxemic pneumonia in children living in developing countries, and to assess factors associated with in-hospital death.

Methods: A multicenter observational study of pneumonia cases, based on the GABRIEL (Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries) network was implemented in Lucknow and Vadu (India), Antananarivo (Madagascar), Bamako (Mali), and San Lorenzo (Paraguay) between 2011-2014. Enrolled patients were hospitalized children aged between 2-60 months with radiologically confirmed pneumonia. Respiratory and whole specimens were collected from all subjects. Microbiological agents associated with hypoxemia at admission (oxygen saturation <90%) were assessed by multivariate logistic regression, and factors associated with in-hospital death were researched by uni- and bivariate Cox proportional hazard models.

Results: Overall, 405 patients with pneumonia, accounting for 3338 days of hospitalization, were analyzed; prevalence of hypoxemia was 17.3% (95% CI: 13.9-21.3%); 13 patients diseased within 2 weeks after hospital admission. Case fatality rate was higher in hypoxemic patients (P=0.01). Detection of human metapneumovirus or RSV from respiratory sample were associated with an increased risk of hypoxemia (adjusted odds ratio [aOR]=2.4, 95% CI: 1.0-5.8; aOR=2.5, 95% CI: 1.1-5.3, respectively), independently of patient age, centre, and calendar time. Lower chest in drawing and cyanosis were predictive of hypoxemia with positive likelihood ratios of 2.3 (95% CI: 1.1-4.9), and 2.4 (IC 95%: 1.4-4.1), respectively. After univariate analysis, S. pneumoniae detected by PCR in blood (crude hazard ratio [cHR]=4.6, 95% CI: 1.5-14.0), procalcitonin≥50 ng/ml (cHR=22.4, 95% CI: 7.3-68.5), and hypoxemia (cHR=4.8, 95% CI: 1.6-14.4) were predictors of death, bivariate analysis confirmed these results.

Conclusion: Human metapneumovirus and RSV from respiratory sample were related to higher risk of hypoxemia while S. pneumoniae from blood was associated with an increased risk of death in children with pneumonia living in developing countries.

Thomas Bénet, MD1,2, Valentina Sanchez Picot, DVM3, Shally Awasthi, MD4, Nitin Pandey, MD5, Ashish Bavdeka, MD6, Sonali Sanghavi, MD6, Anand Kawade, MD7, Annick Robinson, MD8, Mariam Sylla, MD9, Souleymane Diallo, PharmD10, Graciela Russomando, BSc11, Wilma Basualdo, MD12, Melina Messaoudi, MSc13, Florence Komurian-Pradel, PhD13, Hubert Endtz, MD13,14, Philippe Vanhems, MD, PhD1,2,15 and Gláucia Paranhos-Baccalà, PhD13, (1)International Center for Infectiology Research (CIRI), Laboratory of Emerging Pathogens, UCBL1, Lyon, France, (2)Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France, (3)Centre International de Recherche en Infectiologie (CIRI), Fondation Mérieux, Lyon, France, (4)Chatrapati Shahuji Maharaj University, Lucknow, India, (5)Chatrapati Shahuji Maharaj University, Lucknow, India, (6)KEM Hospital Research Center, Pune, India, (7)KEM Hospital Research Center, Pune,, India, (8)Hôpital Femme-Mère-Enfant, Antananarivo, Madagascar, Antananarivo, Madagascar, (9)Pediatric Service, Hopital Gabriel Toure and University of Bamako, Bamako, Mali, (10)Centre d'Infectiologie Charles Mérieux (CICM), Bamako, Mali, (11)Instituto de Investigaciones en Ciencias de la Salud, Asuncion, Paraguay, (12)Research Institute of Health, Research Institute of Health, Asuncion, Paraguay, Paraguay, (13)Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France, (14)Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands, (15)Innovative Clinical Research Network in VACcinology (iREIVAC), Lyon, France

Disclosures:

T. Bénet, None

V. Sanchez Picot, None

S. Awasthi, None

N. Pandey, None

A. Bavdeka, None

S. Sanghavi, None

A. Kawade, None

A. Robinson, None

M. Sylla, None

S. Diallo, None

G. Russomando, None

W. Basualdo, None

M. Messaoudi, None

F. Komurian-Pradel, None

H. Endtz, None

P. Vanhems, None

G. Paranhos-Baccalà, Biomérieux: Collaborator , Research support

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