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Staphylococcal pneumonia in childhood: will early surgical intervention lower mortality?
K F Joosten1, J A Hazelzet, H A Tiddens
1Department of Pediatrics, University Hospital Rotterdam/Sophia Children's Hospital, The Netherlands.
Insights
Staphylococcus aureus pneumonia (SAP) in children is a serious infection with frequent complications. This study found a low mortality rate, possibly due to aggressive surgical intervention and improved supportive care.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Staphylococcus aureus pneumonia (SAP) is a significant pediatric illness with a high complication rate.
- Understanding temporal trends in SAP management and outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze changes in clinical presentation, diagnosis, management, and complications of Staphylococcus aureus pneumonia in children over a 23-year period.
- To evaluate the impact of interventions on SAP outcomes.
Main Methods:
- Retrospective review of medical records for 36 infants and children with SAP admitted between 1970 and 1992.
- Analysis of clinical data, diagnostic procedures, treatment strategies, and patient outcomes.
Main Results:
- Fever and respiratory distress were the predominant symptoms.
- Common chest X-ray findings included pleural effusion (75%), pneumothorax (47%), and abscess/pneumatocele (39%).
- High rates of intervention were observed: thoracentesis (47%), chest tube drainage (58%), thoracotomy (33%), and artificial ventilation (36%).
Conclusions:
- Staphylococcus aureus pneumonia in children can lead to severe complications, including pleural effusion and pneumothorax.
- Aggressive management, including surgical interventions like thoracotomy, combined with supportive care, may contribute to a low mortality rate (6%) in pediatric SAP.
Abstract:
Staphylococcus aureus pneumonia (SAP) continues to be a serious bacterial infection which is associated with a high incidence of complications. We retrospectively reviewed the case records of 36 infants and children admitted with SAP to the Sophia Children's Hospital between 1970 and 1992 to analyse changes over time in the clinical presentation, diagnostic work-up, management and complications. Fifteen of these 36 children (42%) were less than 1 year old. Fever (97%) and respiratory distress (83%) were the most common symptoms at the initial presentation. Chest X-ray findings on admission or during hospitalisation included pleural effusion (75%), pneumothorax (47%), and abscess and/or pneumatocele (39%). Diagnostic and/or therapeutic thoracentesis of pleural fluid was performed in 17 of the 36 patients (47%). Twenty-one patients (58%) needed chest tube drainage. Twelve had a thoracotomy (33%). Artificial ventilation was needed in 13 of the patients (36%). Extrapulmonary complications included convulsions in 6 patients (17%) and osteomyelitis in 2 children (6%). The mean duration of hospitalization was 36 days. Two of the 36 children died (6%). The low mortality rate in this study may be the result of the relatively high rate of thoracotomy and of improvements in supportive treatment.