Related Experiment Video
Updated: Nov 17, 2025
Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Variation in Management and Outcomes of Children With Complicated Pneumonia
Caroline J Gross1,2,3, John J Porter1,4, Susan C Lipsett1,2,4
1Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Insights
Complicated pneumonia, often seen in older children, leads to longer hospital stays and increased resource use compared to community-acquired pneumonia (CAP). This highlights a growing concern in pediatric respiratory infections.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Pneumonia is a leading cause of childhood hospitalization globally.
- Distinguishing between community-acquired pneumonia (CAP) and complicated pneumonia is crucial for appropriate management.
- Complicated pneumonia encompasses severe forms like parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess.
Purpose of the Study:
- To characterize children hospitalized with complicated pneumonia in US children's hospitals.
- To compare the clinical features and outcomes of complicated pneumonia versus CAP.
- To analyze trends in complicated pneumonia prevalence and seasonality.
Main Methods:
- Retrospective analysis of pediatric hospitalizations for complicated pneumonia and CAP across 34 US children's hospitals (2011-2019).
- Evaluation of patient demographics, antibiotic selection, and clinical outcomes.
- Assessment of seasonal patterns and changes in complicated pneumonia incidence over time.
Main Results:
- Children with complicated pneumonia were older (median 6.1 vs 3.4 years) and more likely to be ≥5 years old.
- Higher rates of targeted antibiotics for MRSA and Pseudomonas were observed in complicated pneumonia cases.
- Complicated pneumonia was associated with longer hospital stays, increased ICU admissions, mechanical ventilation, readmissions, and costs.
- The proportion of pneumonia hospitalizations due to complicated pneumonia rose over the study period (OR 1.04).
Conclusions:
- Complicated pneumonia disproportionately affects older children compared to CAP.
- Complicated pneumonia cases demand greater healthcare resources, including extended hospitalization and advanced interventions.
- The increasing prevalence of complicated pneumonia warrants attention in pediatric healthcare settings.
Objectives:
To assess the characteristics of children hospitalized with complicated pneumonia at US children's hospitals and compare these characteristics with those of children hospitalized with community-acquired pneumonia (CAP).
Methods:
We identified children hospitalized with complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess) or CAP across 34 hospitals between 2011 and 2019. We evaluated differences in patient characteristics, antibiotic selection, and outcomes between children with complicated pneumonia and CAP. We, also, assessed seasonal variability in the frequency of these 2 conditions and evaluated the prevalence of complicated pneumonia over the 9-year study period.
Results:
Compared with children hospitalized with CAP (n = 75 702), children hospitalized with complicated pneumonia (n = 6402) were older (a median age of 6.1 vs 3.4 years; P < .001), with 59.4% and 35.2% of patients ≥5 years of age, respectively. Patients with complicated pneumonia had higher rates of antibiotic therapy targeted against methicillin-resistant Staphylococcus aureus (46.3% vs 12.2%; P < .001) and Pseudomonas (8.6% vs 6.7%; P < .001), whereas differences in rates of coverage against mycoplasma were not clinically significant. Children with complicated pneumonia had a longer median hospital length of stay and higher rates of ICU admissions, mechanical ventilation, 30-day readmissions, and costs. Seasonal variation existed in both complicated pneumonia and CAP, with 42.7% and 46.0% of hospitalizations occurring during influenza season. The proportion of pneumonia hospitalizations due to complicated pneumonia increased over the study period (odds ratio 1.04, 95% confidence interval: 1.02-1.06).
Conclusions:
Complicated pneumonia more frequently occurs in older children and accounts for higher rates of resource use, compared to CAP.
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia III: Complications and Assessment
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:29Pneumonia II: Pathophysiology
01:30Chronic Obstructive Pulmonary Disease-V: Nursing Management
Assessment