Clinical Analysis Of Viral–Bacterial Codetection In Neonatal Pneumonia

Objective: To investigate the effects of viral–bacterial codetection on full term neonatal pneumonia severity and follow up the risk of allergic diseases.Methods: Retrospective study on the clinical data of hospitalized neonates with an admitting diagnosis of pneumonia and positive result for a viral respiratory pathogen between Jan 2009 and Dec 2015.Follow up included neonates with viral–bacterial codetection to obtain information on the subsequent development of recurrent wheezing,rhinitis and eczema during the first 3 years of life.Results: 1.During our study,8128 neonates had sputum sample collected to check for respiratory viruses within 24 hours of admission.860(10.6%)cases had positive virus detection.Among them,810 cases with RSV positive,accounting for 94.2%.Other cases included 4 adenovirus,13 influenza virus and 33 parainfluenza virus.2.In RSV-positive patients,363 cases(51.6%)with bacterial codetection,the leading four species of bacteria codetected with RSV were Escherichia coli(27.0%),Klebsiella pneumoniae(22.3%),Staphylococcus aureus(14.6%)and Enterobacter cloacae(9.1%).3.Neonates with codetection of RSV and bacterial pathogen were significantly more likely to present with a higher oxygen requirement,shortness of breath,wheezing,chest retraction,higher C-reactive protein values and more abnormal chest x-rays manifestations than those with detection of RSV only,and there was significant difference(P<0.001).4.By logistic regression analysis and survival statistics,codetection of RSV–Staphylococcus aureus and RSV–Klebsiella pneumoniae in neonatal pneumonia were risk factors of recurrent wheezing during the first 3 years of life.RSV with or without bacterial codetection had no statistically significant difference in the risks of eczema and allergic rhinitis.Conclusions: RSV was the most common viral pathogen in neonatal pneumonia,and RSV could be codetected with Escherichia coli,Klebsiella pneumoniae,Staphylococcus aureus and Enterobacter cloacae.Codetection of RSV and bacteria in neonatal pneumonia was associated with more serious clinical characteristics.The presence of RSV and Staphylococcus aureus or Klebsiella pneumoniae might provide predictive markers for recurrent wheezing.