Epistemic_Statements  

CORD-19:d95aa29fa61c9fd4ee5f7bc29fca44d9e124c517 JSONTXT 11 Projects

Annnotations TAB TSV DIC JSON TextAE Lectin_function

Id Subject Object Predicate Lexical cue
T1 1560-1870 Epistemic_statement denotes Conclusions: These findings highlight the huge proportion of CAP of viral origin, the high number of coinfection by multiple viruses and the low number of bacterial CAP, notably in children under 5 years, and address the need to re-evaluate the indications of empiric antimicrobial treatment in this age group.
T2 2167-2303 Epistemic_statement denotes However, a bacterial origin of CAP has not been documented in a large proportion of cases despite extensive aetiological investigations.
T3 2304-2600 Epistemic_statement denotes The current recommendations [4] [5] [6] encourage pediatricians to prescribe a probabilistic antimicrobial treatment, even when no bacterial infection is documented, which results in prolonged use of antibiotics and in the possible selection of resistant strains within the endogenous flora [7] .
T4 2601-2914 Epistemic_statement denotes Until the beginning of the current century, the absence of documented bacterial infection was attributed to the difficulty in obtaining deep respiratory specimens that are not contaminated by bacteria from the local flora [8] together with the lower sensitivity of blood cultures in proving bacterial sepsis [9] .
T5 3029-3285 Epistemic_statement denotes With the occurrence of new diagnostic tools and notably of multiplex PCR assays able to simultaneously detect a large panel of viruses and atypical bacteria, it now appears that a large proportion of CAP could be related to viral infection [10] [11] [12] .
T6 3286-3518 Epistemic_statement denotes Many studies have evaluated these new tools but most of them were limited to subgroups of children notably to the young [13, 14] , to hospitalized children [11, [13] [14] [15] [16] [17] , or for selected pathogens [10, 12, 18, 19 ].
T7 3519-3837 Epistemic_statement denotes The aim of the present study was to document the presence of a large variety of pathogens in respiratory specimens from children attending the Pediatric Emergency Department of the University hospital of Saint-Etienne, France, during a six-month period and presenting a CAP based on clinical and radiological evidence.
T8 4820-4924 Epistemic_statement denotes A few subjects were excluded after this second reading, notably in the case of associated bronchiolitis.
T9 6440-6580 Epistemic_statement denotes In parallel, blood cultures and pneumococcal antigenuria were tested if prescribed by the clinician, notably in the case of hospitalization.
T10 7618-7882 Epistemic_statement denotes An univaried analysis was performed to compare the cases documented as probably related to a bacterial infection (threshold of 10 7 CFU/ml for conventional cultures [25, 26] or the presence of atypical bacterium by PCR in nasopharyngeal aspirates), and the others.
T11 8198-8417 Epistemic_statement denotes A multivariate analysis of factors independently associated with detection of bacterial was secondarily performed; the parameters included in the logistic regression model were those with P < 0.10 by univaried analysis.
T12 8418-8702 Epistemic_statement denotes Over the six-month period of the study, 95 children thought to have CAP were included; 10 of them were excluded secondarily, comprising 7 cases with non-CAP infection, 2 cases without nasopharyngeal aspirate and one case of CAP whose inclusion was not consented by the child's family.
T13 11259-11630 Epistemic_statement denotes As shown in Table 4 , none of the variables tested was statistically correlated to the presence of a bacterial pathogen by univaried analysis, with the exception of age that was higher in the case of documented bacterial infection (mean age of 5.45 vs 3.49 years; P < 0.05 by Student t test) and the presence of abdominal pain at clinical examination at entry (P = 0.02).
T14 11631-11874 Epistemic_statement denotes Concerning biological parameters, no correlation was observed between bacterial and non-bacterial cases for the most of them, notably for CRP and PCT, with the exception of the white blood cell count that was higher in case of viral infection.
T15 12178-12430 Epistemic_statement denotes Coinfection was not associated to a younger age or a more severe disease, even if the number of detected pathogens tended to be related to the severity of CAP (2.1 infected agents in severe cases vs 1.7 in non-severe cases, P = 0.09 by Student t test).
T16 12431-12540 Epistemic_statement denotes By multivariate analysis, none of the tested variables was independently associated with bacterial infection.
T17 13108-13400 Epistemic_statement denotes Approximately 4 children out of 5 reached hospital without having consulted another physician; most of them had already received an antipyretic treatment, mainly acetaminophen but also non-steroidal anti-inflammatory drugs (NSAID), despite the fact that the use of NSAID may be harmful [27] .
T18 13478-13588 Epistemic_statement denotes In most cases, the first choice for antimicrobial drug was amoxicillin, as currently recommended [4] [5] [6] .
T19 13589-13850 Epistemic_statement denotes Despite the limited size of the present study and its restriction to a single center, its originality lies in the diversity of the included Table 3 Detailed presentation of cases of community-acquired pneumonia exhibiting an infection with at least 2 pathogens.
T20 13981-14165 Epistemic_statement denotes From a microbiological point of view, it is first useful to justify the definition of what level of detection constitutes a causative agent in children with CAP included in this study.
T21 14166-14315 Epistemic_statement denotes Concerning bacterial loads, the threshold of 10 7 CFU/ml was retained as recommended by European experts when induced sputum specimen are used [25] .
T22 15214-15358 Epistemic_statement denotes Eighteen children received antimicrobial therapy before emergency consultation, which could be considered as a source of false-negative culture.
T23 15359-15515 Epistemic_statement denotes However, all of them were always symptomatic at entry, which implies that a bacterium, if present, had a significant opportunity to be recovered by culture.
T24 15516-15851 Epistemic_statement denotes An interesting finding of this study is the large proportion of viral coinfection (43.5%), much higher than that previously reported [10, 12, 30] , notably for bocavirus, metapneumovirus and adenovirus that were detected in association with at least one other virus in more than 80% of the CAP cases involving these agents ( Table 2 ).
T25 15852-15963 Epistemic_statement denotes It has been suggested that infection by several viruses could enhance the severity of CAP [12, [30] [31] [32] .
T26 15964-16223 Epistemic_statement denotes In the present study, a trend was observed in the association between the mean number of infectious agents and the severity of CAP as defined above (P = 0.09); a larger effective size would have been needed to determine a statistically significant difference.
T27 16224-16397 Epistemic_statement denotes In terms of clinical evolution, neither death nor major complications were reported in this study, despite rates of 30.6% for severe pneumonia and 42.4% for hospitalization.
T28 16645-16806 Epistemic_statement denotes This finding raises the question of the systematic use of antimicrobials to treat childhood CAP, which is still recommended in different guidelines [4] [5] [6] .
T29 16807-17027 Epistemic_statement denotes The present findings, together with those of others, allowed the identification of a subpopulation of children less than 5 years of age with mild or moderate symptoms for which a viral etiology of CAP is highly probable.
T30 17237-17456 Epistemic_statement denotes The use of a rapid molecular test detecting a large set of viral and bacterial pathogens within 2 or 3 hours, such as that described in [33] , would allow an improvement in the management of the antimicrobial treatment.
T31 17457-17805 Epistemic_statement denotes In the case of positive result, it would be recommended to avoid the use of amoxicillin as a first-intent therapy (or to prescribe erythromycin in the case of detection of an agent of atypical pneumonia) and to reconsider the use of antimicrobial treatment 24-48 h later according to the clinical evolution and to the results of bacterial cultures.
T32 17806-17944 Epistemic_statement denotes Conversely, the negativity of the rapid test would lead to the empiric prescription of amoxicillin, as currently recommended [4] [5] [6] .
T33 17945-18181 Epistemic_statement denotes It is obvious that this attitude would be dedicated to CAP with mild or moderate symptoms and that CAP with severe presentation at entry should include a systematic probabilistic antimicrobial therapy, whatever the results of PCR assay.
T34 18182-18347 Epistemic_statement denotes The present results are indicative that this strategy could dramatically reduce the proportion of unnecessary antimicrobial treatments in mild or moderate child CAP.
T35 18348-18515 Epistemic_statement denotes Wider studies are needed to prospectively evaluate the benefits of this approach in terms of patient recovery, prevention of antibiotic resistance and medical economy.