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

Table 1 Baseline characteristics and management approach in different types of complicated community-acquired pneumonia, n (%)

Characteristics	PPE (n = 34)	Empyema (n = 31)	NP (n = 15)	P value
Age (years), mean ± SD	5.9 ± 2.8	4.7 ± 2.3	4.1 ± 2.1	0.12
Age sub-group
< 1 year	1 (2.9)	1 (3.3)	3 (20)	0.01a
1-5 years	16 (47.1)	18 (58)	8 (53.3)	0.26
> 5 years	17 (50)	12 (38.7)	4 (26.7)	0.1
Male	17	15	14	0.36
Duration of illness prior to admission (days), mean ± SD	6.5 ± 2.8	7.3 ± 2.2	6.9 ± 2.4	0.47
Not immunized	5 (14.7)	6 (19.3)	3 (20)	0.33
Severe malnutrition	2 (5.8)	9 (29)	1 (6.7)	0.01a
Clinical feature
Cough	30 (88.2)	28 (90.3)	12 (80)	0.56
Fever	33 (97)	31 (100)	15 (100)	0.49
Rapid breathing	29 (85.3)	28 (90.3)	15 (100)	0.62
Chest retraction	25 (73.5)	26 (83.9)	14 (93.3)	0.39
Cyanosis	3 (8.8)	5 (19.3)	2 (13.3)	0.25
Lethargy	3 (8.8)	4 (12.9)	2 (13.3)	0.31
Sepsis	2 (5.8)	2 (6.4)	2 (13.3)	0.09
Shock	-	2 (6.4)	1 (6.7)	0.44
Prior antibiotic use	19 (56)	10 (32)	9 (58)	0.03a
Prior ICD insertion	6 (17.6)	12 (38.7)	1 (6.7)	0.02a
New ICD inserted	5 (14.7)	19 (61.3)	1 (6.7)	0.01a
Fibrinolytic use	-	10 (32.2)	2 (13.3)	0.07
PICU admission	2 (5.8)	9 (29)	3 (20)	0.042a
Invasive mechanical ventilation	1 (2.9)	5 (19.3)	2 (13.3)	0.036a

^aP < 0.05, adjusting after Bonferroni correction.

PPE: Para-pneumonic effusion; NP: Necrotizing pneumonia; CCAP: Complicated community-acquired pneumonia; ICD: Inter-costal chest drain; PICU: Pediatric intensive care unit admission.

Table 2 Clinical course and outcomes in different types of complicated community-acquired pneumonia, n (%)

Characteristics	PPE (n = 34)	Empyema (n = 31)	NP (n = 15)	P value
Time to resolution of fever (days), mean ± SD	10.1 ± 2.4	12.4 ± 2	13.3 ± 2.9	0.26
Time to resolution of illness (days), mean ± SD	10.7 ± 2.9	13.2 ± 2.2	13.9 ± 3.1	0.43
Duration of ICD stay (days), mean ± SD	4.5 ± 1.9	7.1 ± 2.8	6.8 ± 2.3	0.37
Duration of IV antibiotics use (days), mean ± SD	11.3 ± 3.1	14.1 ± 2.8	15.5 ± 3.7	0.08
Duration of hospitalization (days), mean ± SD	13.6 ± 4.2	16.1 ± 7.5	17.7 ± 9.8	0.09
Required change or upgrade of antibiotics	3 (8.8)	9 (26.5)	5 (33.3)	0.03a
Required inotropes for shock	-	2 (6.4)	1 (6.7)	0.51

^aP < 0.05, adjusting after Bonferroni correction.

PPE: Para-pneumonic effusion; NP: Necrotizing pneumonia; CCAP: Complicated community-acquired pneumonia; ICD: Inter-costal chest drain; PICU: Pediatric intensive care unit admission; IV: Intravenous.