Lower Respiratory Tract Disease in Children: Constant Pathogens – Constant Management?!

Abstract

Background: This study analyses the pathogens of acute lower respiratory tract infections (LRI) in children in a German community hospital over six years. Against this background the adoption of new diagnostic and therapeutic guidelines for the LRI management and of RSV-cases in particular is studied.

Methods: 1054 children aged zero to 36 months hospitalized with LRI were prospectively included in the surveillance studies “Parainfluenzavirus (PIV) and Respiratory syncytial virus (RSV) infections in Germany [PRI.de] 1999–2001” and the “pediatric infectious diseases network on acute respiratory tract infections” [PID-ARI.net] for the time period of October 2002 until June 2005. The nasopharyngeal aspirates (NPA) of these children had been analysed for RSV, PIV 1,2,3 and influenzavirus (IV)-A, -B. In 2003/2004 the national guideline on how to diagnose and treat RSV-disease (bronchiolitis) changed. Data on LRI cases severity and especially those regarding the clinical management of RSV-infections were compared to see differences following the release of the guideline.

Results: 84% of the children were between zero and 24 months old. 34% of the NPA specimens were positive for RSV, 7.7% for PIV 1,2,3 and 4.7% for IV-A, -B. Epidemiological findings did not differ substantially between the two studies. Clinical management of RSV-LRI, especially drug use, did not change except for the lower rate of x-ray examination (p<0.01).

Conclusion: The spectrum of causing agents in LRI of children remained quite stable over of six years. Diagnostic and therapeutic concepts remain also stable in a situation where new guidelines were introduced, but not reinforced.

Zusammenfassung

Hintergrund: Die vorliegende Studie beschäftigt sich mit unteren Atemwegsinfektionen bei Kindern in einem deutschen Krankenhaus über den Zeitraum von sechs Jahren. Neben den auslösenden Erregern wird die Umsetzung der aktuellen therapeutischen und diagnostischen Leitlinien (LL) für die Behandlung von akuten unteren Atemwegsinfektionen am Beispiel von RSV-Infektionen untersucht.

Methoden: 1054 Kinder, die im Alter zwischen 0 und 36 Monaten wegen einer akuten unteren Atemwegsinfektion hospitalisiert waren, wurden prospektiv in die Studien „Parainfluenzavirus (PIV) und Respiratory-Syncytial-Virus (RSV) infections in Germany [PRI.de] 1999–2001” und „Pediatric infectious diseases network on acute respiratory tract infections [PID-ARI.net] 2002–2005” eingeschlossen. Das Nasopharyngealsekret (NPS) von diesen Kindern wurde auf RSV-, PIV 1,2,3 und Influenzavirus(IV) A und B untersucht. Die LL zur Diagnostik und Behandlung von RSV-Infektionen (Bronchiolitis) änderten sich 2003/2004. Die Daten der Kinder mit akuten unteren Atemwegsinfektionen und im Speziellen die therapeutischen und diagnostischen Maßnahmen bei Kindern mit RSV-Infektionen wurden zwischen beiden Studien verglichen, um den Einfluss der LL-Änderung zu verfolgen.

Ergebnisse: 84% der Kinder waren zwischen null und 24 Monaten alt. 34% der NPS-Proben waren positiv für RSV, 7.7% für PIV 1,2,3 und 4.7% für IV-A und -B. Die epidemiologischen Daten unterscheiden sich nicht wesentlich zwischen den beiden Studien. Das therapeutische Vorgehen bei durch RSV bedingten unteren Atemwegsinfektionen änderte sich nicht. Röntgen-Thorax-Untersuchungen wurden in der späteren Studie weniger angefordert (p<0.01).

Schlussfolgerung: Das Spektrum der verantwortlichen Erreger für akute untere Atemwegsinfektionen bei Kindern blieb weitgehend stabil über sechs Jahre. Die diagnostischen und therapeutischen Konzepte waren ebenfalls gleichbleibend trotz neuer LL, die bekannt gemacht, nicht aber speziell implementiert wurden.

Key words

respiratory pathogens - respiratory syncytial virus - lower respiratory tract infection - childhood

Schlüsselwörter

respiratorische Pathogene - respiratorischer Syncytial-virus - untere Atemwegsinfektion - Kindheit

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