Clinical profile and outcome of complicated community-acquired pneumonia in children in the post-pneumococcal vaccination era

Abstract

BACKGROUND

Pediatric complicated community-acquired pneumonia (CCAP) is on the rise. The three subtypes include para-pneumonic effusion (PPE), necrotizing pneumonia (NP), and empyema.

AIM

To study different sub-types of pediatric CCAP, and compare their etiology, clinical profile, and outcome in the post-pneumococcal vaccination era.

METHODS

This prospective observational study was conducted over a 2-year period. All details (demographics, clinical, management, and outcomes) were recorded. Continuous data were presented either as mean and SD, or as median and inter-quartile range. Categorical data were presented as frequencies and percentages (%). Data were analyzed by using the IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY, United States).

RESULTS

Of the 80 cases included (71% aged 4-8 years), the distribution was as follows: PPE (42%), empyema (39%), and NP (19%). Bacterial etiology was identified in 28% (empyema 63%, P = 0.012). Staphylococcus aureus (45%) was most common followed by Escherichia coli (E. coli) (22.7%), and Streptococcus pneumoniae (13.6%). Patients with empyema, compared to PPE and NP, were less likely to receive prior antibiotics (32% vs 56% and 58%, respectively, P = 0.03). Duration (days, mean ± SD) of hospitalization was longer in children with NP compared to empyema and PPE (17.7 ± 9.8, 16.1 ± 7.5, and 13.6 ± 4.2, respectively). All children recovered with the medical management except 2 children requiring decortication.

CONCLUSION

Staphylococcus aureus and E. coli are the most common bacterial etiology in the post-pneumococcal vaccination era. Empyema might be related to a delay in antibiotics administration. NP is the most severe pediatric CCAP with prolonged hospitalization.

Keywords: Para-pneumonic effusion; Necrotizing pneumonia; Empyema; Fibrinolytics; Pediatrics

Core Tip: Complicated community-acquired pneumonia (CCAP) follows a severe course, and involve complications such as para-pneumonic effusion, necrotizing pneumonia (NP), empyema, or lung abscess. Present study conducted 5 years after introduction of pneumococcal vaccine in India found Staphylococcus aureus and Escherichia coli as the most common bacterial etiology of pediatric CCAP. In addition, empyema was found to be due to a delay in antibiotics administration, and NP was the most severe pediatric CCAP with prolonged hospitalization. This is important as far as the empirical antibiotics as well as further management of pediatric CCAP cases are concerned.