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Background  The comparison of the frequencies of bacterial and viral infections among children with community-acquired pneumonia (CAP) admitted in distinct severity categories, in an original study, is lacking in literature to-date. We aimed to achieve this goal.    Methods  Children aged 2-59-months-old hospitalized with CAP were included in this prospective study in Salvador, Brazil. Clinical data and biological samples were collected to investigate 11 viruses and 8 bacteria. Severity was assessed by using the World Health Organization criteria.    Results  One hundred eighty-one patients were classified as “non-severe” ( n  = 53; 29.3 %), “severe” ( n  = 111; 61.3 %), or “very severe” ( n  = 17; 9.4 %) CAP. Overall, aetiology was detected among 156 (86.2 %) cases; viral ( n  = 84; 46.4 %), bacterial ( n  = 26; 14.4 %) and viral-bacterial ( n  = 46; 25.4 %) infections were identified. Viral infection frequency was similar in severe/very severe and non-severe cases (46.1 %  vs . 47.2 %;  p  = 0.9). Pneumococcal infection increased across “non-severe” (13.2 %), “severe” (23.4 %), and “very severe” (35.3 %) cases (qui-squared test for trend  p  = 0.04). Among patients with detected aetiology, after excluding cases with co-infection, the frequency of sole bacterial infection was different ( p  = 0.04) among the categories; non-severe (12.5 %), severe (29.3 %) or very severe (55.6 %). Among these patients, sole bacterial infection was independently associated with severity (OR = 4.4 [95 % CI:1.1–17.6];  p  = 0.04) in a model controlled for age (OR = 0.7 [95 % CI:0.5–1.1];  p  = 0.1).    Conclusions  A substantial proportion of cases in distinct severity subgroups had respiratory viral infections, which did not differ between severity categories. Bacterial infection, particularly pneumococcal infection, was more likely among severe/very severe cases.    Electronic supplementary material  The online version of this article (doi:10.1186/s12887-016-0645-3) contains supplementary material, which is available to authorized users.

bmc pediatrics

Comparison of the frequency of bacterial and viral infections among children with community-acquired pneumonia hospitalized across distinct severity categories: a prospective cross-sectional study