# Clinical and microbiological profile of pneumonia among children with congenital heart diseases at alexandria university children’s hospital

## TL;DR

This study identifies common pneumonia pathogens and risk factors for mortality in children with heart conditions at a hospital in Alexandria.

## Contribution

The study combines PCR and culture methods to identify pathogens in children with congenital heart disease and pneumonia.

## Key findings

- Respiratory Syncytial Virus, Rhinovirus, and Klebsiella pneumoniae were the most common causes of pneumonia in children with CHD.
- Pulmonary hypertension, complications, and mechanical ventilation were significant risk factors for mortality.
- Combining PCR and culture methods improved the accuracy and speed of pathogen identification.

## Abstract

Pneumonia is a significant cause of morbidity and mortality among children with congenital heart diseases (CHD). Consequently, the current study aimed to identify the prevalent pathogens causing pneumonia among children with CHD, as well as risk factors for mortality among this vulnerable group.

Over a period of one year, all children with CHD who were hospitalized due to pneumonia, including both community-acquired (CAP) and hospital-acquired pneumonia (HAP) were enrolled. Samples of non-bronchoscopic bronchoalveolar lavage (NB-BAL) or induced sputum were collected to identify pathogens using both FTD® (Fast Track Diagnostics) real-time multiplex PCR and traditional culture methods. The VITEK 2 compact system (BioMérieux, Durham, NC, USA) was employed for the complete identification of all bacterial species and for assessing the antimicrobial resistance of all isolated bacteria by culture methods.

The present study included 99 children with CHD and pneumonia; 88.9% had CAP and 11.1% had HAP. Viral pneumonia represented 46.5% of cases; Respiratory Syncytial Virus (31.1%), Rhinovirus (15.6%), and adenoviruses (12.2%) were the most common. Bacterial pneumonia was found in 23.23% of cases; Klebsiella pneumoniae (56.3%) and Streptococcus pneumoniae (17.2%) were the most common. Out of the studied cases, 75.76% survived and 24.24% deceased. Pulmonary hypertension (95% CI: 1.045–14.907, p=0.027), complications (95% CI: 7.45–162.723, p=0.026), and the need for mechanical ventilation (95% CI: 12.711–207.308, p<0.001) were independent risk factors of mortality.

RSV, Klebsiella pneumoniae , and Rhinovirus are common causes of pneumonia in CHD in our setting. The combination of culture techniques and multiplex PCR was beneficial for the accurate and timely identification of the causative agents of pneumonia in this vulnerable population that helps in guiding antimicrobial therapy.