---
title: "Pathogen Distribution and Antimicrobial Resistance in Severe Community-Acquired Bacterial Pneumoni"
id: "pubmed-42527135"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42527135"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42527135/"
doi: "10.3760/cma.j.cn112140-20260130-00096"
published_at: "2026-08-02T00:00:00.000Z"
evidence_level: "English Abstract"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Pathogen Distribution and Antimicrobial Resistance in Severe Community-Acquired Bacterial Pneumoni
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42527135
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42527135/)
- **DOI:** [10.3760/cma.j.cn112140-20260130-00096](https://doi.org/10.3760%2Fcma.j.cn112140-20260130-00096)
- **Published At:** 2026-08-02T00:00:00.000Z
- **Evidence Rating:** English Abstract
## Executive GIST (TL;DR)
- This retrospective cohort study analyzed 308 children with severe community-acquired bacterial pneumonia (SCABP) admitted to a single PICU from January 2018 to December 2024. - A total of 426 non-duplicate bacterial isolates were recovered from bronchoalveolar lavage fluid and sputum; 77.5% (330/426) were **Gram-negative** and 22.5% (96/426) were Gram-positive. - The five most common pathogens were **Acinetobacter baumannii** (84, 19.7%), **Haemophilus influenzae** (76, 17.8%), **Streptococcus pneumoniae** (49, 11.5%), **Staphylococcus aureus** (47, 11.0%), and **Pseudomonas aeruginosa** (39, 9.2%). - Temporal trends (2018–2024) showed a significant rise in isolation of **Haemophilus influenzae** from 8.3% (6/72) in 2018 to 36.1% (22/61) in 2024. Isolation rates of **Acinetobacter baumannii** and **Streptococcus pneumoniae** declined significantly over the same period (AB: 33.3% to 4.9%; SP: 16.7% to 1.6%). - High resistance rates were observed for H. influenzae to ampicillin (72.4%), TMP-SMZ (71.1%), azithromycin (63.2%), and cefuroxime (60.5%); H. influenzae remained fully susceptible to ceftriaxone. - No P. aeruginosa isolates showed resistance to amikacin or piperacillin–tazobactam in the study period. - S. pneumoniae isolates were universally resistant to erythromycin and clindamycin and 71.4% resistant to TMP-SMZ, but fully susceptible to amoxicillin–clavulanate. - S. aureus had an 85.1% resistance rate to penicillin but retained full susceptibility to vancomycin, linezolid, minocycline, tigecycline, TMP-SMZ, and rifampicin. - Overall conclusion: **Gram-negative bacteria predominate** in pediatric SCABP in this PICU; the pathogen spectrum shifted over time with H. influenzae emerging as the leading pathogen and showing high multi-drug resistance. Ongoing surveillance and susceptibility-guided antibiotic selection are recommended. - Study setting: Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University; retrospective design; conflict of interest: none declared.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China. * 2 Department of Pediatrics, Wuxi Xishan People's Hospital, Wuxi 214105, China. * PMID: **42527135** * DOI: [ 10.3760/cma.j.cn112140-20260130-00096 ](https://doi.org/10.3760/cma.j.cn112140-20260130-00096) Item in Clipboard # [Pathogen distribution and antimicrobial resistance in severe community-acquired bacterial pneumonia in the pediatric intensive care unit] [Article in Chinese] M Y Xin et al. Zhonghua Er Ke Za Zhi. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhonghua Er Ke Za Zhi Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhonghua+Er+Ke+Za+Zhi%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhonghua+Er+Ke+Za+Zhi%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42527135/) . 2026 Aug 2;64(8):911-916. doi: 10.3760/cma.j.cn112140-20260130-00096. ### Authors [M Y Xin](https://pubmed.ncbi.nlm.nih.gov/?term=Xin+MY&cauthor_id=42527135)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China."), [Y J Shan](https://pubmed.ncbi.nlm.nih.gov/?term=Shan+YJ&cauthor_id=42527135)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China."), [J Y Dou](https://pubmed.ncbi.nlm.nih.gov/?term=Dou+JY&cauthor_id=42527135)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China."), [Y C Zhang](https://pubmed.ncbi.nlm.nih.gov/?term=Zhang+YC&cauthor_id=42527135)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China."), [H Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+H&cauthor_id=42527135)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-2 "Department of Pediatrics, Wuxi Xishan People's Hospital, Wuxi 214105, China."), [Y Cui](https://pubmed.ncbi.nlm.nih.gov/?term=Cui+Y&cauthor_id=42527135)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42527135/#short-view-affiliation-1 "Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China.") ### Affiliations * 1 Pediatric Intensive Care Unit, Children's Hospital of Shanghai Jiao Tong University, Shanghai 200062, China. * 2 Department of Pediatrics, Wuxi Xishan People's Hospital, Wuxi 214105, China. * PMID: **42527135** * DOI: [ 10.3760/cma.j.cn112140-20260130-00096 ](https://doi.org/10.3760/cma.j.cn112140-20260130-00096) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42527135/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42527135/#zho-abstract) **Objective:** To analyze the pathogen distribution and antimicrobial resistance profiles of severe community-acquired bacterial pneumonia (SCABP) in children admitted to the pediatric intensive care unit (PICU). **Methods:** This retrospective cohort study included 308 children with SCABP treated at the PICU of Children's Hospital of Shanghai Jiao Tong University between January 2018 and December 2024. A total of 426 non-duplicate pathogenic bacteria were isolated from bronchoalveolar lavage fluid and sputum specimens. Antimicrobial susceptibility testing was performed for all isolates. Patients were stratified by admission year and the trends in isolation rates were tested using the Cochran-Armitage trend test. **Results:** A total of 426 non-duplicate pathogens were isolated from the 308 pediatric patients (178 males, 130 females), comprising 330 strains (77.5%) Gram-negative and 96 strains (22.5%) Gram-positive bacteria. The 5 most common organisms were: _Acinetobacter baumannii_ (AB, 84 strains, 19.7%), _Haemophilus influenzae_ (HI, 76 strains, 17.8%), _Streptococcus pneumoniae_ (SP, 49 strains, 11.5%), _Staphylococcus aureus_ (SA, 47 strains, 11.0%), and _Pseudomonas aeruginosa_ (PA, 39 strains, 9.2%). Over the study period, HI emerged as the leading pathogen in 2024, with its isolation rate rising significantly from 8.3% (6/72) in 2018 to 36.1% (22/61) in 2024. In contrast, the isolation rates of AB and SP declined significantly from 33.3% (24/72) and 16.7% (12/72) in 2018 to 4.9% (3/61) and 1.6% (1/61) in 2024, respectively (_χ_ 2 for trend=18.75, 27.50, 9.50, all _P_ <0.05). The overall resistance rates of HI to ampicillin, trimethoprim-sulfamethoxazole (TMP-SMZ), azithromycin, and cefuroxime were 72.4% (55/76), 71.1% (54/76), 63.2% (48/76), and 60.5% (46/76), respectively, while it remained fully susceptible to ceftriaxone. No PA isolates exhibited resistance to amikacin or piperacillin-tazobactam throughout the study. SP was universally resistant to erythromycin and clindamycin, with 71.4% (35/49) resistance to TMP-SMZ, while remaining fully susceptible to amoxicillin-clavulanate. SA had an 85.1% (40/47) resistance rate to penicillin, but retained complete susceptibility to vancomycin, linezolid, minocycline, tigecycline, TMP-SMZ, and rifampicin. **Conclusions:** Gram-negative bacteria predominate in SCABP among PICU patients. The pathogen spectrum has shifted significantly over time, with HI emerging as the predominant causative agent and exhibiting high resistance to multiple antibiotics. Ongoing surveillance and susceptibility-guided antibiotics selection are essential in clinical management. **目的：** 分析儿童重症社区获得细菌性肺炎（SCABP）病原菌分布特征及耐药性。 **方法：** 回顾性队列研究。收集2018年1月至2024年12月上海交通大学医学院附属儿童医院重症监护病房（PICU）收治的308例SCABP患儿的人口学特征、实验室指标等临床资料，对患儿支气管肺泡灌洗液和痰液标本中分离出的426株非重复病原菌进行菌种分布与药物敏感性分析。根据入院年份分组，线性变化趋势采用Cochran-Armitage趋势检验。 **结果：** 308例SCABP患儿（男178例、女130例）共分离非重复菌426株，其中革兰阴性菌330株（77.5%），革兰阳性菌96株（22.5%）。排名前5位的细菌依次为鲍曼不动杆菌（AB）84株（19.7%）、流感嗜血杆菌（HI）76株（17.8%）、肺炎链球菌（SP）49株（11.5%）、金黄色葡萄球菌（SA）47株（11.0%）和铜绿假单胞菌（PA）39株（9.2%）。HI于2024年成为SCABP首位致病菌，分离率由2018年的8.3%（6/72）升至2024年的36.1%（22/61），AB与SP的分离率分别由2018年的33.3%（24/72）和16.7%（12/72）降至2024年的4.9%（3/61）和1.6%（1/61），差异均有统计学意义（ _χ_ 2趋势=18.75、27.50、9.50，均 _P_ <0.05）。HI对氨苄西林、甲氧苄啶磺胺甲噁唑（TMP-SMZ）、阿奇霉素及头孢呋辛的总耐药率高达72.4%（55/76）、71.1%（54/76）、63.2%（48/76）、60.5%（46/76），对头孢曲松则保持全敏感。在整个研究周期内未分离出PA对阿米卡星及哌拉西林他唑巴坦的耐药菌株。SP对红霉素、克林霉素全耐药，对TMP-SMZ总耐药率为71.4%（35/49），对阿莫西林克拉维酸全敏感。SA对青霉素的总耐药率高达85.1%（40/47），对万古霉素、利奈唑胺、米诺环素、替加环素、TMP-SMZ及利福平全敏感。 **结论：** SCABP以革兰阴性菌感染为主。病原菌谱发生动态变化，HI已成为SCABP主要致病菌且对多种抗菌药物保持高耐药率，临床应结合药敏结果合理选用抗菌药物。. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 所有作者声明无利益冲突 ## Similar articles * [ [Bacterial Infection Spectrum and Antimicrobial Resistance in 2850 Cases of Community-Acquired Pneumonia in Children]. ](https://pubmed.ncbi.nlm.nih.gov/41536653/) Zhong M, Xie J, Wang H, Fan J, Li M, Zou F, Li L.Zhong M, et al.Sichuan Da Xue Xue Bao Yi Xue Ban. 2025 Nov 20;56(6):1521-1527. doi: 10.12182/20251160202.Sichuan Da Xue Xue Bao Yi Xue Ban. 2025.PMID: 41536653Free PMC article.Chinese. * [ [Identification of respiratory pathogenic bacteria and analysis of drug resistance results of patients with nursing home acquired pneumonia in a nursing home in Shanghai City from 2021 to 2023]. ](https://pubmed.ncbi.nlm.nih.gov/41429553/) Hu J, Yang PP, Zhao YY, Du SS, Wu XY.Hu J, et al.Zhonghua Yu Fang Yi Xue Za Zhi. 2025 Dec 6;59(12):2181-2187. doi: 10.3760/cma.j.cn112150-20250413-00304.Zhonghua Yu Fang Yi Xue Za Zhi. 2025.PMID: 41429553Chinese. * [ [Analysis of distribution characteristics and drug resistance of 2748 strains of pathogens isolated from burn patients]. ](https://pubmed.ncbi.nlm.nih.gov/22781318/) Peng DZ, Liu XL, Liu ZY, Shu WT, Zhou X, Liu J, Huang YS, Wu J, Fu WL.Peng DZ, et al.Zhonghua Shao Shang Za Zhi. 2012 Apr;28(2):87-95.Zhonghua Shao Shang Za Zhi. 2012.PMID: 22781318Chinese. * [ [Guidelines for treatment of pneumonia in intensive care units]. ](https://pubmed.ncbi.nlm.nih.gov/16801748/) Emmi V.Emmi V.Infez Med. 2005;Suppl:7-17.Infez Med. 2005.PMID: 16801748Review.Italian. * [ Literature review on the distribution characteristics and antimicrobial resistance of bacterial pathogens in neonatal sepsis. ](https://pubmed.ncbi.nlm.nih.gov/32102584/) Wang J, Zhang H, Yan J, Zhang T.Wang J, et al.J Matern Fetal Neonatal Med. 2022 Mar;35(5):861-870. doi: 10.1080/14767058.2020.1732342. 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