Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
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Etiology and Risk Factors of Community-Acquired Pneumonia in Hospitalized Children During the COVID-19 Pandemic in South Korea

국내 코로나19 판데믹 기간 발생한 입원을 요하는 소아청소년 지역사회폐렴의 원인과 위험 인자

  • Hae Min Kang (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Seung Ha Song (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Bin Ahn (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Ji Young Park (Department of Pediatrics, Chung-Ang University Hospital, College of Medicine, Chung-Ang University) ;
  • Hyunmi Kang (Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Byung Ok Kwak (Department of Pediatrics, Hallym University Sacred Heart Hospital) ;
  • Dong Hyun Kim (Department of Pediatrics, Inha University Hospital, Inha University College of Medicine) ;
  • Joon Kee Lee (Department of Pediatrics, Chungbuk National University Hospital) ;
  • Soo-Han Choi (Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jae Hong Choi (Department of Pediatrics, Jeju National University Hospital, Jeju National University School of Medicine) ;
  • Eun Hwa Choi (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Ki Wook Yun (Department of Pediatrics, Seoul National University Children's Hospital)
  • 강혜민 (서울대학교 어린이병원 소아청소년과) ;
  • 송승하 (서울대학교 어린이병원 소아청소년과) ;
  • 안빈 (서울대학교 어린이병원 소아청소년과) ;
  • 박지영 (중앙대학교병원 소아청소년과) ;
  • 강현미 (서울성모병원 소아청소년과) ;
  • 곽병옥 (한림대학교 성심병원 소아청소년과) ;
  • 김동현 (인하대학교병원 소아청소년과) ;
  • 이준기 (충북대학교병원 소아청소년과) ;
  • 최수한 (부산대학교병원 소아청소년과) ;
  • 최재홍 (제주대학교병원 소아청소년과) ;
  • 최은화 (서울대학교 어린이병원 소아청소년과) ;
  • 윤기욱 (서울대학교 어린이병원 소아청소년과)
  • Received : 2022.10.05
  • Accepted : 2023.06.11
  • Published : 2023.07.03
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Abstract

Purpose: This study aimed to identify the etiology and risk factors of community-acquired pneumonia (CAP) requiring hospitalization in Korean children during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Clinical information of children admitted with CAP to Seoul National University Children's Hospital (SNUCH) between January 1, 2021, and February 28, 2022, was retrospectively collected and analyzed. In addition, the etiologic diagnosis and demographic data of children with CAP who were discharged at the other seven hospitals between January and February 2022 were collected. Pneumonia was diagnosed using strict criteria comprising clinical symptoms, physical examination findings, and chest radiographic findings. Results: Among 91 children hospitalized with CAP at SNUCH during the 14-month period, 68.4% were aged <5 years and 79.1% had underlying diseases. Among the 95 CAP cases, respiratory assistance was required in 70.5%, and the use of a ventilator was required in 20.0%. A total of five patients expired, all of whom were either immunocompromised or had underlying neurological diseases. Neurological diseases and immunosuppression were significantly correlated with respiratory assistance (P=0.003) and death (P=0.014). A total of 55% of the detected respiratory pathogens were viruses, the most common of which was rhinovirus at 35.9%. Among the 169 children hospitalized for CAP at the eight institutions, ≥1 respiratory virus was detected in 92.3%, among which respiratory syncytial virus (79.8%) was the most prevalent. Conclusions: Even during the COVID-19 pandemic, Korean children were hospitalized with CAP caused by seasonal respiratory viral pathogens. Although atypical and pyogenic bacteria were not detected, continuous clinical monitoring and further prospective studies should be conducted.

목적: 국내 소아청소년에서 지역사회폐렴의 원인병원체 분포에 대해 잘 설계된 임상 연구가 부족한 실정이다. 코로나 19 판데믹 기간 동안 국내 소아청소년에서 진단된 입원을 요하는 지역사회폐렴의 역학과 위험인자를 파악하고 지역사회폐렴의 치료 방침 결정의 기초자료를 제공하고자 하였다. 방법: 2021년 1월 1일부터 2022년 2월 28일 사이에 서울대학교 어린이병원에 지역사회폐렴으로 입원한 소아청소년 및 2022년 1월과 2월 전국 7개 대학병원에 지역사회폐렴으로 입원한 소아청소년의 임상 정보를 후향적으로 수집하고 분석하였다. 해당 연구 기간 동안 참여 기관들에서는 폐렴 진단명을 임상 증상과 진찰 소견, 그리고 흉부방사선 소견에 대해 각각 엄격한 기준을 적용하고 이를 종합해서 선별적으로 넣도록 하였고, 이들에 대해 추후에 의무기록 분석을 통해 다시 한번 폐렴 진단의 적절성을 평가하여 최종적으로 연구 대상자 여부를 결정하였다. 결과: 코로나19 유행기의 14개월 동안 서울대학교 어린이병원에 지역사회폐렴으로 입원한 소아청소년은 총 91명이었다. 이 중 5세 이하가 68.1%로 높은 비중을 보였고, 79.1%는 기저질환을 가지고 있었다. 총 95건의 지역사회폐렴 중 호흡 보조가 필요했던 경우는 70.5%였으며, 인공호흡기는 20.0%에서 적용되었다. 최종적으로 5명의 사망자가 발생하였고 모두 면역저하 혹은 신경계 기저질환이 있었다. 위험인자분석에서도 신경계 기저질환과 면역저하상태는 각각 호흡 보조(P=0.003) 및 사망(P=0.014)과 유의한 상관관계가 있었다. 검출된 호흡기 병원체의 54.7%는 바이러스였고 그 중 리노바이러스의 비율이 35.9%로 가장 높았다. 2022년 초 2개월 간 8개 기관에서 지역사회폐렴 진단 하에 퇴원한 소아청소년은 총 169명이었고, 이들 중 92.3%에서 한 개 이상의 호흡기바이러스가 검출되었으며 대부분 respiratory syncytial virus (79.8%)였다. 결론: 코로나19 판데믹 기간에도 국내 소아청소년들이 주로 계절성 호흡기바이러스에 의해 발생한 지역사회폐렴으로 입원치료를 받았다. 주요 세균성 폐렴의 원인균들은 아직 유행이 없으나 지속적인 임상 감시와 연구가 필요하다.

Keywords

Acknowledgement

This study was supported by a 2021 grant from the Korean Society of Pediatric Infectious Diseases and a grant from the National Institute of Infectious Diseases of the National Institute of Health of Korea Disease Control and Prevention Agency (grant No.20211209C4A), Republic of Korea.

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