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Complicated Community-Acquired Pneumonia in Children: An Updated Systematic Review of Literature and Meta-Analysis

Ilaria Liguoro1, Giada Piccinin2, Ilaria Praturlon2

  • 1Division of Pediatrics, University Hospital of Udine, Udine, Italy.

Pediatric Pulmonology
|November 12, 2025
PubMed

Insights

Conservative treatment for complicated community-acquired pneumonia (CCAP) in children leads to longer hospital stays and more treatment failures than surgery. However, clear guidelines for early surgical intervention in pediatric CCAP are still needed.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Complicated community-acquired pneumonia (CCAP) incidence is rising in children.
  • Current guidelines lack consensus on surgical intervention indications for pediatric CCAP.
  • Previous reviews were limited by low-quality evidence.

Purpose of the Study:

  • To systematically review and compare conservative versus surgical management of pediatric CCAP.
  • To evaluate outcomes including length of stay, treatment failure, complications, and mortality.

Main Methods:

  • Systematic review of PubMed, Scopus, and Web of Science databases.
  • Inclusion of studies comparing conservative treatment with surgery in children <18 years.
  • Meta-analysis of length of hospital stay, treatment failure, complications, and mortality.

Main Results:

  • Conservative management (antibiotics, chest drainage) resulted in longer hospital stays (1.82 days) and higher treatment failure rates (RR 2.03) compared to surgery.
  • No significant difference in complication rates (RR 0.92) between conservative and surgical groups.
  • Overall mortality was low, with substantial heterogeneity noted in the included studies.

Conclusions:

  • Conservative CCAP treatment in children is linked to extended hospital stays and increased reintervention needs versus surgical approaches.
  • The optimal timing for surgical intervention in pediatric CCAP remains undetermined.
  • Further research is needed to clarify surgical indications in pediatric complicated pneumonia.
Abstract

Keywords:
community‐acquired pneumoniacomplicated pneumoniaparapneumonic effusionpleural empyema

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