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Published on: February 23, 2014
Fatal community-acquired pneumonia: 18 years in a medical center
Ling-Jen Wang1, Shu-Chi Mu, Cheng-Hui Lin
1Department of Pediatric, Shin Kong WHS Memorial Hospital, Taipei, Taiwan.
Insights
Community-acquired pneumonia (CAP) in children is often fatal. Metabolic acidosis is a key poor prognostic factor, necessitating aggressive treatment with Gram-negative bacilli antibiotics upon early identification.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Community-acquired pneumonia (CAP) is a major global cause of childhood illness and death.
- Identifying risk factors for fatal CAP is crucial for improving treatment outcomes.
- This study investigated the causes and clinical predictors of mortality in pediatric CAP cases.
Purpose of the Study:
- To analyze the etiologies and clinical characteristics of children who died from CAP.
- To identify early indicators of poor prognosis in pediatric CAP.
- To enhance the effectiveness of pneumonia management and reduce mortality rates.
Main Methods:
- Retrospective chart review of children under 18 admitted with pneumonia between 1992 and 2010.
- Included 21 pediatric patients who died from CAP and its complications.
- Compared with 63 age- and year-matched survivors.
Main Results:
- The most common pathogens were Gram-negative bacteria (7 patients) and Mycoplasma pneumoniae (6 patients).
- Fatal CAP was associated with anemia, lymphopenia, thrombocytopenia, bandemia, hyponatremia, sepsis, meningitis, metabolic acidosis, and DIC.
- Metabolic acidosis was a significant prognostic risk factor (OR=8.50, p<0.001).
Conclusions:
- Blood gas analysis should be a routine admission test for pediatric CAP.
- Early identification of poor prognostic factors, like metabolic acidosis, is critical.
- Aggressive treatment, including Gram-negative bacilli antibiotics, should be initiated promptly to prevent fatalities.
Background:
Community-acquired pneumonia (CAP) remains a significant cause of childhood morbidity worldwide. We analyzed the etiologies and the clinical characteristics of children who died from CAP. This study aimed at early identification of the poor prognostic factors in order to improve the efficiency of pneumonia management and prevent deaths.
Methods:
A retrospective chart review was performed for children younger than 18 years admitted to Shin Kong Wu Ho-Su Memorial Hospital between September 1992 and August 2010 with a diagnosis of pneumonia on admission. Twenty-one patients who died with the diagnosis of pneumonia and its complications were included in the study, along with 63 age- and year-matched survival controls.
Results:
Twelve patients (57.1%) were younger than 2 years. Gram-negative bacteria (7 patients) were the most frequently identified pathogen, followed by Mycoplasma pneumoniae (6 patients). Four of these six M. pneumoniae infected patients were co-infected with other pathogens. Among the clinical characteristics, fatal CAP was associated mainly with initial presentations of anemia, lymphopenia, thrombocytopenia, bandemia, hyponatremia, sepsis, meningitis, metabolic acidosis, disseminated intravenous coagulopathy, and underlying congenital diseases. In multivariate logistic regression analysis, metabolic acidosis (odds ratio = 8.50; 95% confidence interval = 2.82-25.60; p < 0.001) was a prognostic risk factor for fatality.
Conclusion:
For patients with CAP, blood gas should be included in the routine blood test on admission. Once the initial blood test associated with the aforementioned poor prognostic factors has been identified, an immediate treatment including Gram-negative bacilli antibiotics should be started aggressively in order to prevent deaths.
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