Microbiological Characteristics of Community-Acquired Pneumonia in Children in Northern Vietnam

ORIGINAL ARTICLE
Tung Anh DINH DUONG, Thi Oanh DAM

 
For citation: DINH DUONG TA, DAM TO. Microbiological Characteristics of Community-Acquired Pneumonia in Children in Northern Vietnam. International Journal of Biomedicine. 2025;15(1):183-187. doi:10.21103/Article15(1)_OA22
 
Originally published March 5, 2025

Abstract: 

Background: This study aimed to identify the distribution of bacteria causing community-acquired pneumonia (CAP) among inpatients at the Respiratory Department of Hai Phong Children’s Hospital and their antibiotic-resistance properties.
Methods and Results: This study analyzed data of 653 inpatients aged 2 months to under 15 years diagnosed with CAP according to WHO criteria recruited from May 1, 2022, to April 30, 2023. The most common bacterial causes of CAP in hospitalized children were Haemophilus influenzae, followed by Streptococcus pneumoniae (25.7%), Moraxella catarrhalis (12.6%), and Staphylococcus aureus (1.4%).  We also found that the most commonly used first-line antibiotics for CAP, such as cephalosporins and broad-spectrum penicillins, were the least effective against these pathogens. Almost all the four types of bacteria tested (H. influenzae, S. pneumoniae, M. catarrhalis, and S. aureus) were found to be multidrug-resistant.
Conclusion: The antibiogram results showed that antibiotic resistance is increasing alarmingly, particularly for first-line antibiotics. Almost all the isolates were multidrug-resistant.

Keywords: 
community-acquired pneumonia • first-line antibiotics • antibiotic resistance • multidrug resistance
References: 
  1. Meyer Sauteur PM. Childhood community-acquired pneumonia. Eur J Pediatr. 2024 Mar;183(3):1129-1136. doi: 10.1007/s00431-023-05366-6. Epub 2023 Dec 19. PMID: 38112800; PMCID: PMC10950989.
  2. Jain S, Williams DJ, Arnold SR, Ampofo K, Bramley AM, Reed C, Stockmann C, Anderson EJ, Grijalva CG, Self WH, Zhu Y, Patel A, Hymas W, Chappell JD, Kaufman RA, Kan JH, Dansie D, Lenny N, Hillyard DR, Haynes LM, Levine M, Lindstrom S, Winchell JM, Katz JM, Erdman D, Schneider E, Hicks LA, Wunderink RG, Edwards KM, Pavia AT, McCullers JA, Finelli L; CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015 Feb 26;372(9):835-45. doi: 10.1056/NEJMoa1405870. PMID: 25714161; PMCID: PMC4697461.
  3. Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019 Aug 31;394(10200):757-779. doi: 10.1016/S0140-6736(19)30721-4. Epub 2019 Jun 27. Erratum in: Lancet. 2019 Aug 31;394(10200):736. doi: 10.1016/S0140-6736(19)32010-0. PMID: 31257127; PMCID: PMC6727070.
  4. Nguyen TK, Tran TH, Roberts CL, Fox GJ, Graham SM, Marais BJ. Risk factors for child pneumonia - focus on the Western Pacific Region. Paediatr Respir Rev. 2017 Jan;21:95-101. doi: 10.1016/j.prrv.2016.07.002. Epub 2016 Jul 15. PMID: 27515732.
  5. WHO Regional Office for Europe/European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2022 – 2020 data. Copenhagen: WHO Regional Office for Europe; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance...
  6. Chokshi A, Sifri Z, Cennimo D, Horng H. Global Contributors to Antibiotic Resistance. J Glob Infect Dis. 2019 Jan-Mar;11(1):36-42. doi: 10.4103/jgid.jgid_110_18. Erratum in: J Glob Infect Dis. 2019 Jul-Sep;11(3):131. doi: 10.4103/0974-777X.265390. PMID: 30814834; PMCID: PMC6380099.
  7. Revised WHO classification and treatment of childhood pneumonia at health facilities. 1 June 2014 | Technical document 1 June 2014.  Available from: https://www.who.int/publications/i/item/9789241507813
  8. Galar A, Yuste JR, Espinosa M, Guillén-Grima F, Hernáez-Crespo S, Leiva J. Clinical and economic impact of rapid reporting of bacterial identification and antimicrobial susceptibility results of the most frequently processed specimen types. Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2445-52. doi: 10.1007/s10096-012-1588-8. Epub 2012 Mar 8. PMID: 22395261.
  9. Aslam B, Wang W, Arshad MI, Khurshid M, Muzammil S, Rasool MH, Nisar MA, Alvi RF, Aslam MA, Qamar MU, Salamat MKF, Baloch Z. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018 Oct 10;11:1645-1658. doi: 10.2147/IDR.S173867. PMID: 30349322; PMCID: PMC6188119.
  10. BAUER AW, PERRY DM, KIRBY WM. Single-disk antibiotic-sensitivity testing of staphylococci; an analysis of technique and results. AMA Arch Intern Med. 1959 Aug;104(2):208-16. doi: 10.1001/archinte.1959.00270080034004. PMID: 13669774.
  11. Basak S, Singh P, Rajurkar M. Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study. J Pathog. 2016;2016:4065603. doi: 10.1155/2016/4065603. Epub 2016 Jan 28. PMID: 26942013; PMCID: PMC4749793.
  12. Honkinen M, Lahti E, Österback R, Ruuskanen O, Waris M. Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clin Microbiol Infect. 2012 Mar;18(3):300-7. doi: 10.1111/j.1469-0691.2011.03603.x. Epub 2011 Aug 18. PMID: 21851481; PMCID: PMC7128628.
  13. Chiang WC, Teoh OH, Chong CY, Goh A, Tang JP, Chay OM. Epidemiology, clinical characteristics and antimicrobial resistance patterns of community-acquired pneumonia in 1702 hospitalized children in Singapore. Respirology. 2007 Mar;12(2):254-61. doi: 10.1111/j.1440-1843.2006.01036.x. PMID: 17298459.
  14. Saraya T. Mycoplasma pneumoniae infection: Basics. J Gen Fam Med. 2017 Apr 17;18(3):118-125. doi: 10.1002/jgf2.15. PMID: 29264006; PMCID: PMC5689399.
  15. GBD 2016 Lower Respiratory Infections Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018 Nov;18(11):1191-1210. doi: 10.1016/S1473-3099(18)30310-4. Epub 2018 Sep 19. PMID: 30243584; PMCID: PMC6202443.
  16. Schuster Bruce C, Hoare C, Mukherjee A, Paul SP. Managing acute respiratory tract infections in children. Br J Nurs. 2017 Jun 8;26(11):602-609. doi: 10.12968/bjon.2017.26.11.602. PMID: 28594619.
  17. Zhou M, Fu P, Fang C, Shang S, Hua C, Jing C, Xu H, Chen Y, Deng J, Zhang H, Zhang T, Wang S, Lin A, Huang W, Cao Q, Wang C, Yu H, Cao S, Deng H, Gao W, Hao J. Antimicrobial resistance of Haemophilus influenzae isolates from pediatric hospitals in Mainland China: Report from the ISPED program, 2017-2019. Indian J Med Microbiol. 2021 Oct-Dec;39(4):434-438. doi: 10.1016/j.ijmmb.2021.09.001. Epub 2021 Sep 21. PMID: 34556347.
  18. Sunakawa K, Farrell DJ. Mechanisms, molecular and sero-epidemiology of antimicrobial resistance in bacterial respiratory pathogens isolated from Japanese children. Ann Clin Microbiol Antimicrob. 2007 Aug 13;6:7. doi: 10.1186/1476-0711-6-7. PMID: 17697316; PMCID: PMC2020463.
  19. Li L, Ma J, Yu Z, Li M, Zhang W, Sun H. Epidemiological characteristics and antibiotic resistance mechanisms of Streptococcus pneumoniae: An updated review. Microbiol Res. 2023 Jan;266:127221. doi: 10.1016/j.micres.2022.127221. Epub 2022 Oct 12. PMID: 36244081.
  20. Zhang Z, Chen M, Yu Y, Pan S, Liu Y. Antimicrobial susceptibility among Streptococcus pneumoniae and Haemophilus influenzae collected globally between 2015 and 2017 as part of the Tigecycline Evaluation and Surveillance Trial (TEST). Infect Drug Resist. 2019 May 10;12:1209-1220. doi: 10.2147/IDR.S203121. PMID: 31190909; PMCID: PMC6524636.
  21. Doi A, Iwata K, Takegawa H, Miki K, Sono Y, Nishioka H, Takeshita J, Tomii K, Haruta T. Community-acquired pneumonia caused by carbapenem-resistant Streptococcus pneumoniae: re-examining its prevention and treatment. Int J Gen Med. 2014 May 21;7:253-7. doi: 10.2147/IJGM.S63744. PMID: 24899822; PMCID: PMC4038523.
  22. Tabassum N, Ahmed A. Determination of anti-microbial susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. J Pak Med Assoc. 2002 Feb;52(2):87-90. PMID: 12073719.
  23. Shaikh SB, Ahmed Z, Arsalan SA, Shafiq S. Prevalence and resistance pattern of Moraxella catarrhalis in community-acquired lower respiratory tract infections. Infect Drug Resist. 2015 Jul 31;8:263-7. doi: 10.2147/IDR.S84209. PMID: 26261422; PMCID: PMC4527568.
  24. Pingault NM, Bowman JM, Lehmann D, Riley TV. Antimicrobial susceptibility of Moraxella catarrhalis isolated from children in Kalgoorlie-Boulder, Western Australia. Pathology. 2010 Apr;42(3):273-9. doi: 10.3109/00313021003631270. PMID: 20350222.
  25. Cillóniz C, Dominedò C, Torres A. Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia. Crit Care. 2019 Mar 9;23(1):79. doi: 10.1186/s13054-019-2371-3. PMID: 30850010; PMCID: PMC6408800.
  26. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x. Epub 2011 Jul 27. PMID: 21793988.
  27. Versporten A, Zarb P, Caniaux I, Gros MF, Drapier N, Miller M, Jarlier V, Nathwani D, Goossens H; Global-PPS network. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey. Lancet Glob Health. 2018 Jun;6(6):e619-e629. doi: 10.1016/S2214-109X(18)30186-4. Epub 2018 Apr 23. Erratum in: Lancet Glob Health. 2018 Sep;6(9):e968. doi: 10.1016/S2214-109X(18)30347-4. PMID: 29681513.
  28. Surveillance of antimicrobial resistance in Europe 2016 [press release]. 2016.

Download Article
Received January 19, 2025.
Accepted March 2, 2025.
©2025 International Medical Research and Development Corporation.