Characteristics and Outcomes of Children With Necrotizing Pneumonia

Abstract

In this study, we describe the characteristics and outcomes of pediatric necrotizing pneumonia in the United States. DESIGN AND SETTING:A retrospective analysis of the Healthcare Cost and Utilization Project 2016 Kids Inpatient Database was performed. The Kids Inpatient Database is a large deidentified hospital discharge database of pediatric patients in the United States. PATIENTS:The database was filtered using International Classification of Diseases, 10th Edition code J85.0 to identify necrotizing pneumonia in children 28 days to 20 years old. INTERVENTIONS:Children with necrotizing pneumonia with and without bacterial isolation and with and without complex chronic conditions were compared. Sample weighting was employed to produce national estimates. MEASUREMENTS AND MAIN RESULTS:Of the 2,296,220 discharges, 746 patients had necrotizing pneumonia (prevalence: 3.2/10,000 discharges). In patients with necrotizing pneumonia, 46.6% required chest tubes, 6.1% underwent video-assisted thoracoscopic surgery, and 27.6% were mechanically ventilated. Pneumothorax was identified in 16.7% and pyothorax in 27.4%. The overall mortality rate was 4.1% (n = 31). Bacterial isolation was documented in 40.9%. The leading organisms identified in patients without a complex chronic condition were Streptococcus pneumoniae (12.6%) and Staphylococcus aureus (9.2%) and in patients with a complex chronic condition were S. aureus (13.4%) and Pseudomonas aeruginosa (12.8%). Patients with bacterial isolation were significantly more likely to develop pneumothorax (odds ratio, 2.6; CI, 1.6-4.2) or septic shock (odds ratio, 3.2; CI, 1.9-5.4) and require a chest tube (odds ratio, 2.5; CI, 1.7-3.5) or mechanical ventilation (odds ratio, 2.3; CI, 1.5-3.3) than patients without bacterial isolation.CONCLUSIONS: Bacterial etiology of necrotizing pneumonia in children varied with the presence or absence of a complex chronic condition. Bacterial isolation is associated with increased invasive procedures and complications. The mortality rate is higher in children with complex chronic conditions. This study provides national data on necrotizing pneumonia among hospitalized children.

Early predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia

“…Etiological analysis suggested that the four most commonly isolated organisms were M. pneumoniae, S. pneumoniae, S. aureus, and P. aeruginosa in all patients, which are similar to those of a recent study 21 ; therefore, it is important to provide empiric antibiotic coverage for these organisms. The composition of the pathogens among the three groups varied widely.…”

Non-Traumatic Hemothorax in a Child with Necrotizing Pneumonia: A Case Report

“…5 The retrospective analysis by Manette et al in 2016 showed half of the patients with necrotizing pneumonia required chest tube drainage, while 6% required video-assisted thoracoscopic surgery. 6 The most common organism identified in this study was streptococcus pneumonia (12.6%) followed by staphylococcus aureus (9.2%) which couldn't be isolated in our case which can be explained by upfront administration of antibiotics before admission. The median age of children with necrotizing pneumonia was 3.2 years in an observational study conducted by Blanco-Iglesias et al where 49 of 51 patients presented with pleural effusion, the causative agent was isolated in two-thirds of cases and pneumococcus was the commonest.…”

Necrotizing Pneumonia in Children: Early Recognition and Management

“…Some viruses and fungi like influenza, parainfluenza, adenovirus, respiratory syncytial virus, Herpes group (including Cytomegalovirus, Varicella-Zoster and the Epstein–Barr Virus), Aspergillus spp., Candida spp., Histoplasma capsulatum , Coccidioides spp., Blastomyces spp. and Cryptococcus neoformans can also cause NP [ 6 , 10 ]. And a synergy between viruses and bacteria is common and sometimes lethal.…”

“…A study in Taiwan found that no underlying diseases may predict the occurrence of necrosis and/or abscess independently [ 5 ]. However, a recent study has shown that NP tended to occur in children with a complex chronic condition, and the mortality rate was higher than that of NP in previously healthy children [ 6 ]. NP is characterized by necrosis and liquification of lung parenchyma and loss of the normal pulmonary parenchymal architecture [ 7 ].…”