Predictors of the severity of community-acquired pneumonia in children and the effectiveness of vaccinal prevention: a retrospective study

Background. The urgency of this problem is due to the fact that respiratory diseases occupy one of the first places in the structure of childhood morbidity. Prediction of the course and outcome of pneumonia requires timely assessment the factors responsible for the development of a severe bacterial inflammatory process. Streptococcus pneumonia remains the leading bacterial causative agent of community-acquired pneumonia (CAP) in the general population of pathogens. Objective: to determine premorbid and clinical risk factors and laboratory predictors of the development of severe pneumonia in children; to evaluate the effect of vaccination against pneumococcus on the incidence of CAP in children in Penza. Methods. Premorbid factors and clinical features of community-acquired pneumonia in 56 children were analyzed; 30 children with severe pneumonia were admitted to the intensive care unit (ICU). One of the predictors of bacterial infection is the plasma procalcitonin (PCT) level. The plasma PCT concentration (with a detection threshold of 0.5 ng/mL) was determined by a semi-quantitative immunochromatographic method for 26 hospitalized children with community-acquired pneumonia. A statistical analisis of the effect of vaccination against pneumococcus on the incidence of community-acquired pneumonia in children in Penza was also performed. Results. The influence of the nature of premorbid factors on the clinical manifestations of severe pneumonia was found, the dependence of the PCT level on the severity of the inflammatory process in the lungs was determined; and it has been proved that CAP incidence in children vaccinated with a 13-valent conjugated pneumococcal vaccine was 3.2 times lower than in unvaccinated children. Conclusion. The group of patients with pneumonia requiring intensive care in ICU is heterogeneous in the nature of the combined pathology, risk factors, severity of respiratory failure syndromes, circulatory disorders, and toxic-hypoxic damage to the central nervous system, which affects the prognosis of the disease, therapy and length of stay in the ICU. The procalcitonin test is an important predictor of severe pneumonia and the development of complications; it is most informative in pulmonary destruction or the formation of a septic process. A direct correlation between the CAP incidence and the level of vaccination against pneumococcus in the child population was found.

Streptococcus pneumonia, children, pneumonia, procalcitonin, Streptococcus pneumonia, vaccination