Severe community-acquired bacterial pneumonia (SCABP) in children admitted to the pediatric intensive care unit (PICU) carries high morbidity and requires prompt, appropriate antimicrobial therapy. This retrospective study aimed to describe the pathogen distribution and antimicrobial resistance patterns among children with SCABP treated in a single tertiary PICU between January 2018 and December 2024.
The investigators performed a retrospective cohort analysis including 308 pediatric patients with SCABP admitted to the PICU of Children's Hospital of Shanghai Jiao Tong University. Respiratory specimens (bronchoalveolar lavage fluid and sputum) yielded 426 non-duplicate bacterial isolates. Antimicrobial susceptibility testing was performed for all isolates. Patients were stratified by year of admission to assess temporal trends in isolation rates using the Cochran–Armitage trend test. The report declares no conflicts of interest.
From the 308 children (178 males, 130 females), 426 non-duplicate bacterial strains were isolated. Of these, 330 strains (77.5%) were Gram-negative bacteria and 96 strains (22.5%) were Gram-positive. The five most frequently isolated organisms were:
These results demonstrate a predominance of Gram-negative pathogens among PICU-treated pediatric SCABP in this cohort.
The pathogen spectrum changed significantly over the study period. Notably, Haemophilus influenzae increased from 8.3% (6/72) of isolates in 2018 to 36.1% (22/61) in 2024. Conversely, Acinetobacter baumannii decreased from 33.3% (24/72) in 2018 to 4.9% (3/61) in 2024, and Streptococcus pneumoniae fell from 16.7% (12/72) to 1.6% (1/61). The Cochran–Armitage trend tests reported statistically significant trends for these changes (reported χ2 for trend values and P < 0.05 in the source).
The study reports organism-specific resistance profiles from susceptibility testing of all isolates.
Haemophilus influenzae
Acinetobacter baumannii
Pseudomonas aeruginosa
Streptococcus pneumoniae
Staphylococcus aureus
The predominance of Gram-negative organisms and the dynamic shift in pathogen distribution—particularly the rise of Haemophilus influenzae with high resistance rates to several commonly used antibiotics—underscore the need for continued local surveillance to guide empiric therapy in PICU patients with SCABP. The reported full susceptibility of H. influenzae to ceftriaxone supports use of third-generation cephalosporins when H. influenzae is suspected and local data align. The preserved activity of amikacin and piperacillin–tazobactam against P. aeruginosa and the retained activity of several agents against S. aureus and S. pneumoniae may influence empiric regimens in severe disease, but selection should be tailored to local susceptibility patterns and individual patient factors.
Strengths:
Limitations (as can be inferred from the abstract):
In this PICU cohort of children with SCABP from 2018 to 2024, Gram-negative bacteria predominated. The pathogen spectrum shifted over time with Haemophilus influenzae emerging as the leading pathogen in 2024 and displaying high resistance rates to multiple antibiotics, while remaining susceptible to ceftriaxone. Continued surveillance and antibiotic selection guided by local susceptibility data are essential for optimal clinical management of severe pediatric community-acquired bacterial pneumonia.