Epidemiology, microbiology, and treatment patterns of pediatric patients hospitalized with pneumonia at two hospitals in China: a patient chart review study

Figures & data

Figure 1 Study flow chart.

Abbreviations: CM, Chinese Medicine; EMR, electronic medical records.

Table 1 Baseline patient demographics, comorbidities, and surgical interventions

Baseline characteristics	Peking University People’s Hospital		Guangdong Provincial Hospital of CM
	0–27 days (n=926)	28 days to 17 years (n=222)	28 days to 17 years (n=3,046)
Age (years), mean ± SD (median)	3.5±5.9 (0)	6.5±5.6 (5)	3.3±3.1 (2)
Gender, n (%)
Male	526 (56.8)	130 (58.6)	1,793 (58.8)
Female	400 (43.2)	92 (41.4)	1,253 (41.1)
Ethnic origin, n (%)
Han Chinese	895 (96.7)	188 (84.7)	3,027 (99.4)
Non-Han Chinese	29 (3.1)	10 (4.5)	16 (0.5)
Unknown	2 (0.2)	24 (10.8)	3 (0.1)
Comorbidities, n (%)	921 (99.5)	208 (93.7)	3,046 (100.0)
Respiratory disease
Bronchial disorder	0 (0.0)	0 (0.0)	66 (2.2)
Bronchopulmonary dysplasia	16 (1.7)	1 (0.5)	0 (0.0)
Tuberculosis	0 (0.0)	0 (0.0)	2 (0.1)
Other lung infections	0 (0.0)	3 (1.4)	0 (0.0)
Tonsillitis	0 (0.0)	0 (0.0)	114 (3.7)
Anemia	497 (53.7)	29 (13.1)	38 (1.3)
Malignant tumor
Solid tumor	0 (0.0)	1 (0.5)	1 (0.0)
Blood tumor	2 (0.2)	135 (60.8)	0 (0.0)
Neonatal hyperbilirubinemia	318 (34.3)	2 (0.9)	0 (0.0)
Septicemia	54 (5.8)	18 (8.1)	14 (0.5)
Renal failure	0 (0.0)	0 (0.0)	1 (0.0)
Treatment and medication, n (%)
Surgical treatment in the 3 months prior to hospitalization	0 (0.0)	0 (0.0)	3 (0.1)
Medication in the 3 months prior to hospitalization	0 (0.0)	15 (6.8)	62 (2.0)

Abbreviation: CM, Chinese Medicine.

Table 2 Bacteria isolated ≥2 hospitalizations at either hospitala

Bacterial strains	Peking University People’s Hospital		Guangdong Provincial Hospital of CM
	0–27 days	28 days to 17 years	28 days to 17 years
Hospitalizations with a microbiological diagnosis, n (%)	24 (2.6)	14 (6.3)	236 (7.7)
Gram-negative bacteria, n (%)
Enterobacteriaceae
Klebsiella pneumoniae	2 (8.3)	0 (0.0)	8 (3.4)
Escherichia coli	1 (4.2)	0 (0.0)	9 (3.8)
Enterobacter cloacae	1 (4.2)	0 (0.0)	6 (2.5)
Pseudomonas spp.
Pseudomonas aeruginosa	1 (4.2)	1 (7.1)	6 (2.5)
Moraxella spp.
Acinetobacter junii	0 (0.0)	3 (21.4)	0 (0.0)
Acinetobacter baumannii	0 (0.0)	1 (7.1)	12 (5.1)
Branhemella catarrhalis	0 (0.0)	0 (0.0)	7 (3.0)
Xanthomonas spp.
Haemophilus spp.
Haemophilus influenzae	0 (0.0)	0 (0.0)	8 (3.4)
Gram-positive bacteria, n (%)
Staphylococcus spp.
Staphylococcus aureus	0 (0.0)	0 (0.0)	20 (8.5)
Methicillin-resistant S. aureus	0 (0.0)	0 (0.0)	3 (1.3)
Methicillin-susceptible S. aureus	0 (0.0)	0 (0.0)	17 (7.2)
Staphylococcus epidermidis	10 (41.7)	1 (7.1)	1 (0.4)
Staphylococcus haemolyticus	4 (16.7)	0 (0.0)	0 (0.0)
Staphylococcus capitis	2 (8.3)	0 (0.0)	0 (0.0)
Staphylococcus hominis	1 (4.2)	1 (7.1)	3 (1.3)
Streptococcus spp.
Streptococcus pneumoniae	0 (0.0)	0 (0.0)	7 (3.0)
Atypical organisms, n (%)
Mycoplasma spp.
Mycoplasma pneumoniae	0 (0.0)	7/50 (14.0)b	154 (65.3)

Notes:

a Some pathogens were identified in multiple different samples from a single patient.

b Identified from blood sample by antibody.

Abbreviation: CM, Chinese Medicine.

Figure 2 Clinical outcomes of neonatal and pediatric patients in Guangdong and Peking University hospitals.

Abbreviation: ICU, intensive care unit.

Table 3 Frequently used antibiotics for initial therapy and overall at both the study hospitals

Antibiotics	Number of patients receiving antibiotics during hospitalization, n (%)
	Guangdong Provincial Hospital of CM (age 28 days to 17 years, n=2,526)		Peking University People’s Hospital (age 0–27 days, n=926)		Peking University People’s Hospital (age 28 days to 17 years, n=212)
	Initial	Overall	Initial	Overall	Initial	Overall
Beta-lactam antibacterials
Penicillins	147 (5.82)	195 (7.72)	19 (77.7)	799 (86.3)	28 (13.2)	46 (21.7)
β-Lactamase sensitive penicillins	141 (5.58)	180 (7.13)	717 (77.4)	797 (86.1)	25 (11.8)	39 (18.4)
Benzylpenicillin	141 (5.58)	180 (7.13)	717 (77.4)	797 (86.1)	25 (11.8)	39 (18.4)
Combinations of penicillins, including	104 (4.12)	140 (5.54)	2 (0.2)	2 (0.2)	1 (0.5)	8 (3.8)
β-lactamase inhibitors
Amoxicillin and clavulanic acid	101 (4.00)	133 (5.27)	2 (0.2)	2 (0.2)	0 (0.00)	0 (0.00)
Piperacillin and tazobactam	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	1 (0.5)	8 (3.8)
Penicillins with extended spectrum	0 (0.00)	22 (0.87)	0 (0.00)	0 (0.00)	4 (1.9)	11 (5.2)
Amoxicillin	0 (0.00)	22 (0.87)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Piperacillin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	4 (1.9)	10 (4.7)
Carbapenems	19 (0.75)	71 (2.81)	1 (0.1)	37 (4.0)	50 (23.6)	97 (45.8)
Meropenem	0 (0.00)	0 (0.00)	1 (0.1)	37 (4.0)	50 (23.6)	97 (45.8)
Imipenem-cilastatin	6 (0.24)	29 (1.15)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
First-generation cephalosporins	5 (0.20)	7 (0.28)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Cefathiamidine	2 (0.08)	3 (0.12)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Second-generation cephalosporins	188 (7.44)	221 (8.75)	0 (0.00)	0 (0.00)	20 (9.4)	41 (19.3)
Cefuroxime	162 (6.41)	175 (6.93)	0 (0.00)	0 (0.00)	17 (8.0)	24 (11.3)
Cefaclor	15 (0.59)	32 (1.27)	0 (0.00)	0 (0.00)	4 (1.9)	21 (9.9)
Third-generation cephalosporins	1,071 (42.40)	1,238 (49.01)	391 (42.2)	586 (63.3)	74 (34.9)	118 (55.7)
Ceftriaxone	996 (39.43)	1,130 (44.73)	0 (0.00)	2 (0.2)	9 (4.3)	11 (5.2)
Cefixime	34 (1.35)	299 (11.84)	0 (0.00)	0 (0.00)	5 (2.4)	41 (19.3)
Ceftazidime	0 (0.00)	0 (0.00)	391 (42.2)	586 (63.3)	56 (26.4)	80 (37.7)
Cefoperazone and sulbactam	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	5 (2.4)	7 (3.3)
Fourth-generation cephalosporins	0 (0.00)	0 (0.00)	33 (3.6)	179 (19.3)	9 (4.3)	33 (15.6)
Cefepime	0 (0.00)	0 (0.00)	33 (3.6)	179 (19.3)	9 (4.3)	33 (15.6)
Macrolides, lincosamides, and streptogramins	1,273 (50.40)	1,735 (68.69)	13 (1.4)	773 (83.5)	60 (28.3)	138 (65.1)
Macrolides	1,199 (47.47)	1,685 (66.71)	13 (1.4)	773 (83.5)	60 (28.3)	137 (64.6)
Azithromycin	1,152 (45.61)	1,655 (65.52)	13 (1.4)	768 (82.9)	59 (27.8)	133 (62.7)
Erythromycin	42 (1.66)	80 (3.17)	0 (0.00)	8 (0.9)	1 (0.5)	9 (4.2)
Lincosamides	75 (2.97)	89 (3.52)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Clindamycin	75 (2.97)	89 (3.52)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Aminoglycoside antibacterials	1 (0.04)	4 (0.16)	14 (1.5)	99 (10.7)	13 (6.1)	30 (14.2)
Gentamicin	1 (0.04)	3 (0.12)			9 (4.3)	18 (8.5)
Tobramycin	0 (0.00)	0 (0.00)	14 (1.5)	99 (10.7)	4 (1.9)	10 (4.7)
Amphenicols	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	7 (3.3)	7 (3.3)
Chloramphenicol	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	7 (3.3)	7 (3.3)
Sulfonamides and trimethoprim	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	5 (2.4)	5 (2.4)
Intermediate-acting sulfonamides	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	5 (2.4)	5 (2.4)
Sulfamethoxazole	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	5 (2.4)	5 (2.4)
Quinolone antibacterials	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	4 (1.9)	16 (7.6)
Fluoroquinolones	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	4 (1.9)	16 (7.6)
Norfloxacin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	2 (0.9)	2 (0.9)
Levofloxacin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	8 (3.8)
Other antibacterials	3 (0.12)	5 (0.20)	0 (0.00)	0 (0.00)	53 (25.0)	108 (50.9)
Steroid antibacterials	1 (0.04)	2 (0.08)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Fusidic acid	1 (0.04)	2 (0.08)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)
Glycopeptide antibacterials	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	47 (22.2)	102 (48.1)
Norvancomycin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	47 (22.2)	96 (45.3)
Vancomycin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	12 (5.7)
Teicoplanin	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	7 (3.3)
Imidazole derivatives	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	18 (8.5)	102 (48.1)
Metronidazole	0 (0.00)	0 (0.00)	0 (0.00)	0 (0.00)	18 (8.5)	35 (16.5)
Others	1 (0.04)	4 (0.16)	0 (0.00)	0 (0.00)	0 (0.00)	12 (5.7)
Linezolid	1 (0.04)	4 (0.16)	0 (0.00)	0 (0.00)	0 (0.00)	12 (5.7)

Abbreviation: CM, Chinese Medicine.