European Journal of Pediatrics

, Volume 168, Issue 12, pp 1429–1436 | Cite as

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

  • Manon Cevey-MacherelEmail author
  • Annick Galetto-Lacour
  • Alain Gervaix
  • Claire-Anne Siegrist
  • Jacques Bille
  • Béatrice Bescher-Ninet
  • Laurent Kaiser
  • Jean-Daniel Krahenbuhl
  • Mario Gehri
Original Paper


Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunization.


Community-acquired pneumonia Child WHO guidelines Pneumococcal infection Antibiotic Immunization 



Community-acquired pneumonia


World Health Organization


C-reactive protein




Nasopharyngeal aspirates


British Thoracic Society


Nasopharyngeal swabs


White blood cell


Upper respiratory symptoms


Human metapneumovirus



This study was supported in part by GlaxoSmithKline. We thank Dr. B. Vaudaux, infectious disease pediatrician at the University Hospital of Lausanne, for his advices. We are grateful to Mrs. J. Bersier and her laboratory staff, to Dr. Wunderli and his collaborators for the viral serology test, to Dr. K. Jaton and her collaborators for the M. pneumoniae and C. pneumoniae PCR tests, to S. Grillet for the pneumococcal serology analyses, to Prof. J. Schrenzel for pneumococcal PCR, and to Sabine Nobs-Grunenwald for viral PCR analysis.

Conflicts of interest

All the authors certify that they have no financial relationship with the organization that partly sponsored the research and no conflicts of interest.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Manon Cevey-Macherel
    • 1
    • 6
    Email author
  • Annick Galetto-Lacour
    • 2
  • Alain Gervaix
    • 2
  • Claire-Anne Siegrist
    • 3
  • Jacques Bille
    • 4
  • Béatrice Bescher-Ninet
    • 5
  • Laurent Kaiser
    • 5
  • Jean-Daniel Krahenbuhl
    • 1
  • Mario Gehri
    • 1
  1. 1.Child and Adolescent DepartmentLausanne University HospitalLausanneSwitzerland
  2. 2.Child and Adolescent DepartmentUniversity Hospital of GenevaGenevaSwitzerland
  3. 3.Center for Vaccine and Neonatal Immunology, Departments of Pediatrics and Pathology-ImmunologyUniversity of GenevaGenevaSwitzerland
  4. 4.Institute of MicrobiologyUniversity of LausanneLausanneSwitzerland
  5. 5.Central Laboratory of Virology, Division of Infectious Diseases and Faculty of MedicineUniversity Hospital of GenevaGenevaSwitzerland
  6. 6.Pediatric DepartmentLausanne University HospitalLausanneSwitzerland

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