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Published on: March 12, 2020

Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia

A J McKee1, A Ives, I M Balfour-Lynn

  • 1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK.

Pediatric Pulmonology
|June 1, 2011
PubMed

Insights

Complicated pediatric pneumonia cases, including bronchopleural fistulas, significantly increased in 2008-2009. This rise was linked to Streptococcus pneumoniae serotype 3 infections, not covered by the then-current vaccine.

Area of Science:

  • Pediatric Infectious Diseases
  • Pulmonary Medicine
  • Microbiology

Background:

  • Complicated pneumococcal disease, including necrotizing pneumonia, has seen a rise.
  • An increase in pediatric empyema complicated by bronchopleural fistula and air leak was observed during 2008-2009.
  • The study aimed to identify potential causes for this observed increase.

Purpose of the Study:

  • To investigate the association between the increased incidence of bronchopleural fistulas in children with empyema and potential causative factors.
  • To compare the characteristics and outcomes of pediatric empyema cases with and without bronchopleural fistulas between two distinct time periods.

Main Methods:

  • Retrospective review of pediatric cases with parapneumonic effusion or empyema admitted between 2002-2007 and 2008-2009.
  • Comparison of the frequency of air leaks and bronchopleural fistulas between the two study periods.
  • Analysis of clinical outcomes, including hospital stay and surgical intervention rates, and identification of Streptococcus pneumoniae serotypes.

Main Results:

  • The frequency of air leaks/bronchopleural fistulas rose dramatically from 1% (2002-2007) to 33% (2008-2009) (P<0.0001).
  • Cases with bronchopleural fistulas showed significantly longer hospital stays (median 10 vs. 7 days) and higher surgical intervention rates (14% vs. 2%).
  • Streptococcus pneumoniae serotype 3 was identified in 91% of fistula cases versus 3% of non-fistula cases in the latter period.

Conclusions:

  • A marked increase in pediatric bronchopleural fistulas occurred in 2008-2009.
  • The rise in fistulas was associated with Streptococcus pneumoniae serotype 3 infections.
  • The role of serotype 3 prevalence changes in this increased incidence requires further investigation, especially considering the heptavalent pneumococcal vaccine's limitations at the time.
Abstract

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