Estarão diferentes as pneumonias agudas adquiridas na comunidade com internamento hospitalar em idade pediátrica na última década?

Abstract

The past few years have seen a decline in community acquired pneumonia (CAP) in children in the western world, although this has gone hand-in-hand with more serious cases needing hospital admission. Our study characterises cases of CAP admitted to hospital and compares this data with a 2001 study. We collected data on 63 admissions over a six-month period. The majority were aged 0-2 years old. Chest X-ray showed consolidation/atelectasy in 58 (92.1%) and pleural effusion (PE) in 17 (27.0%), of which 11 were empyema (17.4% of all admissions). The bacterial agent was isolated in five cases: Streptococcus pyogenes (two, pleural fluid), Streptococcus pneumoniae (two, blood culture) and Haemophilus influenzae (one, blood culture). Sixty-one children (96.8%) were prescribed antibiotherapy. The median length of hospital stay was five days. Patients with PE were older, had a longer course of fever, higher inflammatory parameters, longer hospital stay and longer course of iv antibiotics. Compared to the prior study we found greater severity of CAP, with higher prevalence of PE and empyema. Nevertheless there was a shorter course of fever during hospital stay and shorter hospital stay. We also noticed less antibiotic prescription prior to admission and greater prescription of ampicillin during hospital stay. In the literature, the higher severity of CAP has been partially attributed to the emergence of more aggressive serotypes of Stretococcus pneumoniae not included in the heptavalent vaccine. There is therefore a greater interest in new vaccines containing them. Complicated CAP should be referred to centres specialising in its diagnosis and management.

Community-acquired lobar pneumonia in children in the era of universal 7-valent pneumococcal vaccination: a review of clinical presentations and antimicrobial treatment from a Canadian pediatric hospital

“…The 7-valent pneumococcal conjugate vaccine (Prevnar®, PCV-7) became available in Canada in 2000, and was added to the routine Ontario immunization schedule in January 2005 [2]. Introduction of the pneumococcal vaccine has been shown to decrease all-cause radiologic pneumonia admission rates by an average of 27% in children under the age of 5 years [3-10]. …”

Empyema and bacteremic pneumococcal pneumonia in children under five years of age

“…( 3 ) In another study, empyema was found in 83 (11%) of 767 children hospitalized with CAP; in comparison with the children with CAP without empyema, those with empyema were older, had longer symptomatic periods, and were more likely to receive nonsteroidal anti-inflammatory drugs. ( 4 ) The objective of the present study was to compare children under 5 years of age with BPP and those with pneumococcal empyema (PE) in terms of their clinical, radiological, and laboratory features.…”

“…Bacteremic pneumococcal pneumonia (BPP) is considered an advanced stage of severe pneumococcal pneumonia, in which early recognition and appropriate management can have a favorable impact on the outcome. ( 3 ) Given that pleural empyema and BPP are potentially severe, it is important to recognize their clinical peculiarities in order to provide early and appropriate management.…”

“…A pneumonia pneumocócica bacterêmica (PPB) é considerada um estágio avançado da pneumonia pneumocócica grave, em que o reconhecimento precoce e o manejo adequado podem ter efeito positivo no desfecho. ( 3 ) Como o empiema pleural e a PPB são potencialmente graves, é importante reconhecer suas peculiaridades clínicas a fim de administrar prontamente o tratamento oportuno.…”

“…( 3 ) Em outro estudo, empiema foi encontrado em 83 (11%) de 767 crianças hospitalizadas com PAC; em comparação com as crianças com PAC sem empiema, as com empiema eram mais velhas, apresentavam períodos sintomáticos mais longos e tinham mais chance de receber anti-inflamatórios não esteroides. ( 4 ) O objetivo do presente estudo foi comparar crianças menores de 5 anos com PPB àquelas com empiema pneumocócico (EP) quanto a suas características clínicas, radiológicas e laboratoriais.…”