Etiological Characteristics and Risk Factors for Severe Disease in Bocavirus-Associated Community-Acquired Pneumonia in Children: A Multicenter Retrospective Study

Objective This is a multicenter retrospective study aimed to evaluate the concordance between nucleic acid testing and targeted next-generation sequencing (tNGS) for etiologic detection, and to identify potential risk factors for severe community-acquired pneumonia (SCAP), thereby providing evidence for precision clinical management. Methods We retrospectively analyzed 191 pediatric Community-Acquired Pneumonia(CAP) cases positive for bocavirus by tNGS from April 2023 to June 2025. Etiologic concordance and coinfection patterns were evaluated. Univariate and multivariate logistic regression identified independent risk factors for SCAP. Results There are 191 children were included. Significant heterogeneity was observed among the four centers in age distribution, SCAP incidence, imaging findings, and treatment patterns ( P  < 0.05). Children’s Hospital, Zhejiang University School of Medicine (ZCH) reported the highest SCAP incidence (50.0%), with markedly higher rates of pulmonary consolidation (66.7%), atelectasis (100.0%), and pleural effusion (16.7%) compared with other centers, whereas DY had the lowest SCAP incidence (11.0%). The bocavirus positivity rate by tNGS was 100.0%, significantly higher than that of nucleic acid testing (51.3%). tNGS identified 44 cases of mixed infection (23.0%), including 35 bacterial (18.3%) and 7 viral coinfections (3.7%), whereas nucleic acid testing identified only 9 mixed infections (4.7%). tNGS demonstrated a clear advantage in detecting mixed and bacterial infections ( P  < 0.001). Multivariate logistic regression revealed that age < 3 years, oxygen supplementation, dyspnea, wheezing, plastic bronchitis, pulmonary consolidation, atelectasis, and pleural effusion were independent risk factors for SCAP ( P  < 0.05). Conclusion Clinical profiles of bocavirus-associated CAP vary significantly across centers. tNGS offers superior sensitivity and breadth in pathogen detection. Early recognition of high-risk children—particularly those < 3 years, requiring oxygen, exhibiting respiratory distress, or showing radiologic abnormalities—is essential for timely SCAP management.