Epidemiology and Etiology of Hospitalized Pneumonia in Children

描述（由申请方提供）：儿童肺炎是全球5岁以下儿童发病和死亡的主要原因。在美国，肺炎和流感是儿童死亡的第八大原因。虽然肺炎在儿童中的负担是很好的理解，最近的数据，在儿童肺炎的发病率和病因很少。到目前为止，确定肺炎的真正病因是复杂的，因为1）可能导致肺炎的大量细菌和病毒因子; 2）病毒和细菌合并感染的频率; 3）儿童深呼吸道标本的可用性有限; 4）当前实验室技术的局限性和5）在微生物学评价之前开始抗生素治疗。这些局限性导致儿童肺炎的经验性临床管理。儿科肺炎的最佳管理取决于对不同年龄和地理区域引起肺炎的病原体的流行病学的了解。 犹他州大学与联合和地区大学病理学家实验室和研究企业以及爱达荷州技术公司合作，是唯一适合解决这个问题的。作为CDC指导的多中心研究的一部分，我们正在进行一项前瞻性研究，以确定导致住院儿童社区获得性肺炎和复杂性细支气管炎的病毒和细菌病原体。为了确定儿科住院肺炎的发病率和病因，并进一步了解与流感相关的并发症，我们提出了以下具体目标：具体目标1：确定盐湖县所有诊断和住院的儿童临床诊断和放射学确诊的CAP。具体目标二：确定盐湖县儿童流感相关肺炎的人群发病率、病因和结局，包括原发性病毒性肺炎、病毒和细菌合并感染以及流感后细菌性肺炎。具体目标3：使用分子分析和高阶多重检测记录由已确定和新出现的病原体引起的儿科肺炎的细菌和病毒病因。通过对胸水和血液进行分子分析，提高确定假定细菌感染病因的能力。肺炎住院患儿呼吸道病毒载量的定量和比较。

DESCRIPTION (provided by applicant): Pneumonia in children is a major cause of morbidity and the leading cause of death in children younger than 5 years of age worldwide. Among children in the United States, pneumonia and influenza are the eighth leading causes of death. Although the burden of pneumonia in children is well appreciated, recent data on the incidence and etiology of pneumonia in children are few. Thus far, determining the true etiology of pneumonia is complicated due to 1) the large number of bacterial and viral agents that may cause pneumonia; 2) the frequency of viral and bacterial co-infections; 3) the limited availability of deep respiratory specimens from children; 4) the limitations of current laboratory technology and 5) antibiotic therapy initiated before microbiological evaluation. These limitations result in empirical clinical management of children with pneumonia. The optimum management of pediatric pneumonia is dependent on understanding the epidemiology of the pathogens that cause pneumonia by age and geographic region. The University of Utah, in collaboration with the Associated and Regional University Pathologists Laboratories and Research Enterprise, as well as Idaho Technology, Inc., is uniquely suited to address this problem. As part of a multicenter research study directed by the CDC, we are conducting a prospective study to identify viral and bacterial pathogens which cause community-acquired pneumonia and complicated bronchiolitis in hospitalized children. To determine the incidence and etiology of pediatric hospitalized pneumonia and to further understand the complications associated with influenza, we propose the following Specific Aims: Specific Aim 1: Identify all children in Salt Lake County diagnosed and hospitalized for clinically diagnosed and radiologically-confirmed CAP. Specific Aim 2: Determine the population-based incidence, etiology, and outcomes of pediatric influenza-associated pneumonia in Salt Lake County, including primary viral pneumonia, viral and bacterial co-infection, and post-influenza bacterial pneumonia. Specific Aim 3: Document the bacterial and viral etiology of pediatric pneumonia due to established and emerging pathogens using molecular analysis and high-order multiplex testing. Improve the ability to identify the etiology of presumed bacterial infection using molecular analysis of pleural fluid and blood. Quantify and compare respiratory viral loads in children hospitalized with pneumonia.