Pediatric Community-acquired Pneumonia with High Coinfection Burden: A Single-center Experience in Taiwan

Abstract

Background: Community-acquired pneumonia (CAP) remains a leading cause of pediatric hospitalization worldwide. However, the role of viral–bacterial coinfections and the clinical utility of multiplex polymerase chain reaction (PCR) diagnostics in pediatric CAP remain insufficiently defined. Aim: The aim of the study was to evaluate the distribution of pathogens and clinical outcomes associated with viral, bacterial, and mixed infections in children hospitalized with CAP, using multiplex PCR testing. Methods: This retrospective study reviewed hospitalized pediatric patients (<18 years) with CAP who underwent multiplex PCR testing (FilmArray respiratory panel and pneumonia panel) at a tertiary medical center in Taiwan between January 2022 and June 2024. Patients were categorized into six pathogen-defined groups. Clinical characteristics, laboratory findings, antibiotic use, and outcomes were analyzed. Results: Among 42 children, 50% had coinfections. Human rhinovirus/enterovirus and Mycoplasma pneumoniae were the most frequently identified viral and bacterial pathogens, respectively. Compared to those with single viral infections, patients with mixed infections involving bacteria were older. In contrast, multiple viral infections occurred more frequently in younger children. All patients received empirical antibiotic therapy irrespective of pathogen identification. Intensive care unit admission was determined by clinical severity rather than PCR findings, while PCR facilitated post hoc etiologic clarification. No significant difference was observed in length of hospital stay across infection groups (P = 0.210). Conclusion: Viral–bacterial coinfection was frequent among pediatric CAP cases and tended to be associated with older age, although markers of severity did not differ significantly between groups. Integration of multiplex PCR into clinical algorithms may enhance targeted antimicrobial stewardship in pediatric CAP management. Future prospective, multicenter studies are warranted to validate these preliminary findings and assess cost-effectiveness.