Distribution of Respiratory Pathogens After the COVID-19 Pandemic: A Single-Center Pediatric Study From Türkiye

Öz

Introduction: This study aimed to evaluate the frequency and typing of viral and bacterial pathogens in patients with a preliminary diagnosis of respiratory tract infection during the epidemic period in Türkiye. Material and Method: The study included the respiratory pathogen analysis results of 215 patients aged 0–17 years admitted to the Pediatrics Department of Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital between October 2022 and March 2023 with symptoms of respiratory tract infections. Twenty-three viruses and six bacteria in the respiratory panel were studied using multiplex real-time PCR. Samples were obtained from a nasopharyngeal swab in non-intubated patients and tracheal aspiration material in intubated patients. Results: While 92.1% of the patients were positive for one or more agents, no agent was detected in 7.9%. Among the positive results, the rate of the single pathogen was 27.3% (n=54), while the rate of multiple pathogens was 72.7% (n=144). Respiratory syncytial virus was the most common viral agent with a rate of 23.3% and Adenovirus with a rate of 19.1%, while Haemophilus influenzae (48.8%) and Streptococcus pneumoniae (29.3%) were the most common bacterial agents. Conclusion: In this study, viral and bacterial pathogens have been studied intensively in children. Simultaneous, rapid, and sensitive detection of these agents is essential in preventing unnecessary antibiotic use and infection control. This is also important in terms of reducing mortality and morbidity rates.

Anahtar Kelimeler

• COVID-19
• pandemic
• respiratory pathogens
• respiratory syncytial viruses

Kaynakça

1. 1. Camara M, Dieng A, Diop A, Diop A, Diop A, Bouh S, et al. Antibiotic resistance of bacteria responsible for acute respiratory tract infections in children. Microbiologia Medica. 2017;32(1):6489.
2. 2. Bayrakdar F, Altaş AB, Korukluoğlu G. Solunum yolu viruslerinin 2009–2012 yılları arasında ülkemizdeki mevsimsel dağılımı. Türk Mikrobiyol Cem Derg. 2013;43(1):56–66.
3. 3. Şirin MC. Isparta İlinde Akut Solunum Yolu Enfeksiyonu Ön Tanısı Olan Hastalarda Multipleks PCR Yöntemiyle Viral ve Bakteriyel Etkenlerin Sıklığının Araştırılması. Med J SDU. 2022;29(2):171–8.
4. 4. Hacımustafaoğlu MK, Gürler N, Ünal S. Üst solunum yolu infeksiyonlarının ampirik tedavisinin planlamasında antimikrobiyal direnç: Türkiye ve dünyadaki mevcut durum ve mücadele stratejileri. ANKEM Derg. 2018;32(3):109–30.
5. 5. Krause JC, Panning M, Hengel H, et al. The role of multiplex PCR in respiratory tract infections in children. Dtsch Arztebl Int. 2014;111(1):639–45.
6. 6. Özdamar M, Türkoğlu S. Detection of respiratory pathogens in lower respiratory tract infections by multiplex real time PCR in Kocaeli/Istanbul province in 2015–2017. Medeniyet Med J. 2018;33(3):188–94.
7. 7. Wu F, Zhao S, Yu B, Chen YM, Wang W, Song ZG, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579(7798):265–9.
8. 8. Gomez GB, Mahé C, Chaves SS. Uncertain effects of the pandemic on respiratory viruses. Science. 2021;372(6546):1043–4.

9. 9. Şık N, Çakan Başerdem KA, Başerdem O, Appak Ö, Sayiner AA, Yilmaz D, et al. Distribution of Viral Respiratory Pathogens During the COVID-19 Pandemic: A Single-Center Pediatric Study from Turkey. Turk Arch Pediatr. 2022;57(3):354–9.
10. 10. Kuşkucu MA, Mete B, Tabak F, Midilli K. Yetişkinlerde Solunum Yolu Viral Etkenlerinin 2010–2018 Yılları Arasındaki Prevalansı ve Mevsimsel Dağılımı. Turk Mikrobiyol Cem Derg. 2020;50(1):21–6.
11. 11. Andrews D, Chetty Y, Cooper BS, Virk M, Glass SK, Letters A, et al. Multiplex PCR point of care testing versus routine, laboratory-based testing in the treatment of adults with respiratory tract infections: a quasi-randomised study assessing impact on length of stay and antimicrobial use. BMC Infectious Diaseases. 2017;17(1):1–11.
12. 12. Saarela E, Tapiainen T, Kauppila J, Pokka T, Uhari M, Kauma H, et al. Impact of multiplex respiratory virus testing on antimicrobial consumption in adults in acute care: a randomized clinical trial. Clin Microbiol Infect. 2020;26(1):506–11.
13. 13. Esposito S, Daleno C, Prunotto G, Scala A, Tagliabue C, Borzani I, et al. Impact of viral infections in children with communityacquired pneumonia: results of a study of 17 respiratory viruses. Influenza Other Respir Viruses. 2013;7(1):18–26.
14. 14. Kanberoğlu Gİ, Güdeloğlu E, Bağ Ö, Ecevit Ç. Akut alt solunum yolu enfeksiyonu nedeniyle hastaneye yatan çocuklarda Multiplex-PCR ile saptanan enfeksiyöz etkenlerin değerlendirilmesi. Pam Tıp Derg. 2021;14(3):604–10.
15. 15. Kurskaya O, Ryabichenko T, Leonova N, Shi W, Bi H, Sharshov K, et al. Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013–2017). PLoS One. 2018;18;13(9):e0200117.
16. 16. Uyar M, Kuyucu N, Tezcan S, Aslan G, Taşdelen B. Bronşiyolit tanısı alan 0–2 yaş grubu çocuklarda insan bokavirus ve diğer solunum viruslarının sıklığının araştırılması. Mikrobiyol Bul. 2014;48(2):242–58.
17. 17. Appak Ö, Duman M, Belet N, Sayıner AA. Viral respiratory infections diagnosed by multiplex polymerase chain reaction in pediatric patients. J Med Virol. 2019;91(5):731–7.
18. 18. Goka EA, Vallely PJ, Mutton KJ, Klapper PE. Single and multiple respiratory virus infections and severity of respiratory disease: a systematic review. Paediatr Respir Rev. 2014;15(4):363–370.
19. 19. Dereci S, Çopur Çiçek A, Özkasap S, Mutlu MA, Koçyiğit S, Şahin K. Distribution of respiratory viruses which cause lower respiratory tract infection in pediatric age group. J Coast Life Med. 2015;3(7):547–50.
20. 20. Özdamar M, Türkoğlu S. Detection of respiratory pathogens in lower respiratory tract infections by multiplex real time PCR in Kocaeli/Istanbul province in 2015–2017. Medeniyet Med J. 2018;33(3):188–94.
21. 21. Ağca H, Akalın H, Ali R, Çetin ED, Cilo BD, Kazak E. Nötropenik Hastaların Solunum Yolu Örneklerinde Viral Etkenlerin Araştırılması. Turk Mikrobiyol Cem Derg. 2019;49(3):125–31.
22. 22. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. 2010;Lancet 375:154555.
23. 23. Lee J, Choi EH, Lee HJ. Comprehensive serotyping and epidemiology of human Adenovirus isolated from the respiratory tract of Korean children over 17 consecutive years (1991–2007). J Med Virol. 2010;82(4):624–31.
24. 24. Aydın E, Aydın N, Perçin Renders D. Pediatrik Hastalarda Akut Gastroenterit Etkenlerinin Laboratuvar Parametrelerine Etkisinin Değerlendirilmesi. Flora. 2022;27(1):125–34.
25. 25. Şamlıoğlu P, Karaca Derici Y, Yılmaz N. Alt Solunum Yolu İnfeksiyonlarında Polimeraz Zincir Reaksiyonu ile Saptanan Bakteriyel Etkenlerin Değerlendirilmesi. Flora. 2020;25(1):2832.
26. 26. Aydemir Y, Aydemir Ö, Pekcan S, Özdemir M. Value of multiplex PCR to determine the bacterial and viral aetiology of pneumonia in school-age children. Paediatr Int Child Health. 2017;37(1):29–34.
27. 27. Zhang D, He Z, Xu L, Zhu X, Wu J, Wen W, et al. Epidemiology characteristics of respiratory viruses found in children and adults with respiratory tract infections in southern China. Int J Infect Dis. 2014;25:159–64.
28. 28. Çolak M, Aktaş Tapısız A, Güzel Tunçcan Ö, Bozdayı G. COVID-19 pandemisi öncesinde Coronaviridae ailesi pozitifliğinin ve mevsimsel dağılımının;retrospektif olarak değerlendirilmesi (2016–2020). Flora. 2020;25(4):480–9.
29. 29. Çiçek C, Bayram N, Anıl M, Gülen F, Pullukçu H, Saz EU, et al. Solunum virusları ve influenza A virus alt tiplerinin multipleks PCR yöntemi ile aynı anda saptanması. Mikrobiyol Bul. 2014;48(4):652–60.
30. 30. Şirin MC. Isparta İlinde Akut Solunum Yolu Enfeksiyonu Ön Tanısı Olan Hastalarda Multipleks PCR Yöntemiyle Viral ve Bakteriyel Etkenlerin Sıklığının Araştırılması. Med J SDU. 2022;29(2):171–8.
31. 31. Falsey AR, Becker KL, Swinburne AJ, Nylen ES, Formica MA, Hennessey PA, et al. Bacterial complications of respiratory tract viral illness: a comprehensive evaluation. J Infect Dis. 2013;208(3):432–41.
32. 32. Smith CM, Sandrini S, Datta S, Freestone P, Shafeeq S, Radhakrishnan P, et al. Respiratory syncytial virus increases the virulence of Streptococcus pneumoniae by binding to penicillin binding protein 1a. A new paradigm in respiratory infection. Am J Respir Crit Care Med. 2014;190(2):196–207.
33. 33. Cason C, Zamagni G, Cozzi G, Tonegutto D, Ronfani L, Oretti C, et al. Spread of Respiratory Pathogens During the COVID-19 Pandemic Among Children in the Northeast of Italy. Front Microbiol. 2022;24(13):804700.
34. 34. Şık N, Çakan Başerdem KA, Başerdem O, Appak Ö, Sayıner AA, Yılmaz D et a. Distribution of Viral Respiratory Pathogens During the COVID-19 Pandemic: A Single-Center Pediatric Study from Turkey. Turk Arch Pediatri. 2022;57(3):354–9.
35. 35. Crowe JE Jr, Williams JV. Immunology of viral respiratory tract infection in infancy. Paediatr Respir Rev. 2003;4(2):112–9.
36. 36. Salute M. (2020a). Della Covid-19 Bambini. Available online at: https://www.salute.gov.it/portale/nuovocoronavirus/ dettaglioContenutiNuovoCoronavirus.jsp?lingua=italiano&id =5413&area=nuovoCoronavirus&menu=vuoto (accessed July 30, 2023).
37. 37. Dos Santos C, Capelo A, Cimbro M, Ferrara A. Antimicrobial resistance patterns in respiratory pathogens isolated in an Italian university hospital during a period of eight years: a statistical analysis. Chemotherapy 2000;46(3):166–72.