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Complicated community acquired pneumonia in childhood: Different types, clinical course, and outcome
Ira Erlichman1, Oded Breuer2, David Shoseyov2
1Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Insights
Pediatric community-acquired complicated pneumonia (PCACP) shows ethnic predominance. While necrotizing pneumonia is more severe, all PCACP types have favorable outcomes regardless of treatment, indicating they may represent a spectrum of the same disease.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pediatric community-acquired complicated pneumonia (PCACP) incidence is rising globally.
- Understanding the distinct characteristics and outcomes of different PCACP types is crucial for effective management.
- Investigating treatment protocols' impact on PCACP outcomes is essential.
Purpose of the Study:
- To determine if different types of PCACP (parapneumonic effusion, empyema, necrotizing pneumonia) represent a single disease entity.
- To evaluate the impact of various treatment protocols on patient outcomes in PCACP.
Main Methods:
- Retrospective analysis of medical records for PCACP hospitalizations.
- Inclusion of data from three major Jerusalem hospitals between 2001-2010.
- Collection of demographic, clinical, management, and outcome data.
Main Results:
- Of 144 children, 40% had parapneumonic effusion, 40% empyema, and 20% necrotizing pneumonia.
- Bacterial origin was identified in 42%, with Streptococcus pneumoniae being most common.
- Necrotizing pneumonia cases experienced longer hospitalizations, and prior antibiotic treatment did not alter outcomes for any PCACP type.
Conclusions:
- Necrotizing pneumonia is a more severe manifestation of PCACP, associated with prolonged morbidity.
- All PCACP types demonstrate favorable outcomes upon discharge, irrespective of the treatment protocol used.
- PCACP exhibits ethnic predominance, suggesting potential genetic or environmental factors.
Abstract:
The incidence of pediatric community acquired complicated pneumonia (PCACP) is increasing. Questions addressed: Are different types of PCACP one disease? How do different treatment protocols affect the outcome?
Methods:
Retrospective analysis of medical records of PCACP hospitalizations in the three major hospitals in Jerusalem in the years 2001-2010 for demographics, clinical presentation, management, and outcome.
Results:
Of the 144 children (51% aged 1-4 years), 91% of Jewish origin; 40% had para-pneumonic effusion (PPE), 40% empyema (EMP), and 20% necrotizing pneumonia (NP). Bacterial origin was identified in 42% (empyema 79%, P = 0.009), most common S. pneumoniae (32%), group A streptococcus (9%). Patients with EMP, compared to PPE and NP, were less likely to receive prior antibiotic treatment (35% vs. 57% and 59%, respectively, P = 0.04). Mean hospitalization was longer in patients with NP followed by EMP and PPE (16.4 ± 10.6, 15.2 ± 7.9, and 12.7 ± 4.7 days, respectively), use of fibrinolysis was not associated with the outcome. All children had recovered to discharge regardless of antibiotic therapy or fibrinolysis.
Answer:
NP is a more severe disease with prolonged morbidity and hospitalization in spite of prior antibiotic treatment. All types had favorable outcome regardless of treatment-protocol. Complicated pneumonia has an ethnic predominance. Pediatr Pulmonol. 2017;52:247-254. © 2016 Wiley Periodicals, Inc.
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