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Clinical Profiles, Management, and Outcomes of Complicated Pneumonia in Children: A Retrospective Study from Tertiary
Lina Alshadfan1, Muna Kilani2, Saleh Abualhaj3
1Pediatrics and Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Al Balqa Applied University, Al-Salt P.O. Box 19117, Jordan.
Insights
Prior antibiotic use in children with complicated pneumonia (CP) is linked to longer symptom duration and hospitalization. This highlights the need for optimized antimicrobial stewardship and improved care for pediatric CP.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Clinical microbiology
Background:
- Complicated pneumonia (CP) in children, encompassing empyema, necrotizing pneumonia (NP), and parapneumonic pleural effusion (PPE), presents significant morbidity.
- Despite advances in antimicrobial therapy, CP subtypes require detailed clinical and epidemiological characterization.
Purpose of the Study:
- To compare clinical characteristics, laboratory findings, antibiotic use, and outcomes across different pediatric CP subtypes.
- To assess the impact of prior antibiotic exposure on the presentation and treatment outcomes of hospitalized children with CP.
Main Methods:
- A retrospective observational study of 58 children admitted with CP to tertiary hospitals in Jordan.
- Patients were classified into four subtypes: empyema, NP, NP with PE, and PPE.
- Demographic, clinical, laboratory, antibiotic, and outcome data were analyzed; multivariable regression identified predictors of prior antibiotic use.
Main Results:
- Fever and cough were predominant symptoms (96.6%). Over 40% of patients received prior antibiotics.
- Prior antibiotic exposure correlated with longer symptom duration (8.2 vs. 4.5 days), extended hospitalization (18.2 vs. 14.6 days), and increased chest tube insertion rates (66.7% vs. 35.3%).
- Streptococcus pneumoniae was the most common pathogen; vancomycin-based regimens were frequent treatments.
Conclusions:
- Complicated pneumonia in children is a heterogeneous condition with significant clinical impact.
- Prior antibiotic exposure is associated with prolonged symptom duration and specific clinical interventions in pediatric CP.
- Findings offer insights into local disease patterns and prescribing habits, informing antimicrobial stewardship and care pathway improvements.
Background:
Complicated pneumonia (CP) in children presents in various forms-including empyema, necrotizing pneumonia (NP), necrotizing pneumonia with pleural effusion (NP + PE), and parapneumonic pleural effusion (PPE)-and is associated with significant morbidity despite advances in antimicrobial therapy. This study aimed to describe and compare the clinical characteristics, laboratory findings, antibiotic use, and outcomes across different CP subtypes in hospitalized children and to assess the impact of prior antibiotic use on presentation and treatment outcomes.
Methods:
This retrospective observational study included 58 children admitted with CP to tertiary hospitals in Jordan. Patients were categorized into four subtypes: empyema (n = 4), NP (n = 4), NP + PE (n = 17), and PPE (n = 33). Demographic data, clinical features, laboratory results, antibiotic regimens, and clinical outcomes were analyzed. Multivariable regression was used to identify predictors of prior antibiotic use.
Results:
Fever and cough were the most common symptoms (96.6%). Over 40% of patients had received antibiotics prior to admission. Those pre-treated had significantly longer symptom duration (8.2 vs. 4.5 days, p < 0.001), longer hospitalization (18.2 vs. 14.6 days, p = 0.023), and more frequent chest tube insertion (66.7% vs. 35.3%, p = 0.019). Streptococcus pneumoniae was the most common organism isolated in culture-positive cases. Vancomycin-based regimens were the most frequently used treatments. Univariate regression analysis showed that patients with prior antibiotic use had significantly higher odds of longer hospitalization duration (OR = 1.11, p = 0.028) and chest tube insertion (OR = 3.67, p = 0.021).
Conclusions:
Complicated pneumonia in children remains a diverse and clinically significant condition. The findings demonstrate that prolonged symptom duration prior to hospitalization and certain clinical interventions were associated with prior antibiotic exposure. These results provide insight into local disease patterns and prescribing behaviors, which may help inform strategies to optimize antimicrobial stewardship and improve care pathways for affected children.
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