Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada.
BMC Pediatr. 2012 Aug 28;12:133. doi: 10.1186/1471-2431-12-133.
Community-acquired pneumonia (CAP) is a common cause of pediatric admission to hospital. The objectives of this study were twofold: 1) to describe the clinical characteristics of CAP in children admitted to a tertiary care pediatric hospital in the pneumococcal vaccination era and, 2) to examine the antimicrobial selection in hospital and on discharge.
A retrospective review of healthy immunocompetent children admitted to a tertiary pediatric hospital from January 2007 to December 2008 with clinical features consistent with pneumonia and a radiographically-confirmed consolidation was performed. Clinical, microbiological and antimicrobial data were collected.
One hundred and thirty-five hospitalized children with pneumonia were evaluated. Mean age at admission was 4.8 years (range 0-17 years). Two thirds of patients had been seen by a physician in the 24 hours prior to presentation; 56 (41.5%) were on antimicrobials at admission. 52 (38.5%) of patients developed an effusion, and 22/52 (42.3%) had pleural fluid sampled. Of 117 children who had specimens (blood/pleural fluid) cultured, 9 (7.7%) had pathogens identified (7 Streptococcus pneumoniae, 1 Group A Streptococcus, and 1 Rhodococcus). 55% of patients received 2 or more antimicrobials in hospital. Cephalosporins were given to 130 patients (96.1%) in hospital. Only 21/126 patients (16.7%) were discharged on amoxicillin. The median length of stay was 3 days (IQR 2-4) for those without effusion and 9 (IQR 5-13) for those with effusion. No deaths were related to pneumonia.
This study provides comprehensive data on the clinical characteristics of hospitalized children with CAP in the pneumococcal 7-valent vaccine era. Empiric antimicrobial choice at our institution is variable, highlighting a need for heightened antimicrobial stewardship.
社区获得性肺炎（CAP）是儿童住院的常见原因。本研究的目的有两个：1）描述在肺炎球菌疫苗接种时代，入住三级儿童医院的 CAP 患儿的临床特征；2）检查住院期间和出院时的抗菌药物选择。
对 2007 年 1 月至 2008 年 12 月期间因临床特征符合肺炎且影像学证实实变而入住三级儿科医院的健康免疫功能正常的儿童进行回顾性分析。收集临床、微生物学和抗菌药物数据。
评估了 135 例住院肺炎患儿。入院时的平均年龄为 4.8 岁（范围 0-17 岁）。三分之二的患者在就诊前 24 小时内看过医生；56 例（41.5%）入院时使用了抗菌药物。52 例（38.5%）患儿发生渗出，其中 22/52 例（42.3%）有胸腔液样本。在 117 例有标本（血液/胸腔液）培养的患儿中，有 9 例（7.7%）确定了病原体（7 例肺炎链球菌、1 例 A 组链球菌和 1 例罗地氏球菌）。55%的患儿在医院接受了 2 种或以上的抗菌药物治疗。住院期间给 130 例患儿（96.1%）使用了头孢菌素。仅 21/126 例（16.7%）患儿出院时使用阿莫西林。无肺炎相关死亡病例。
本研究提供了肺炎球菌 7 价疫苗时代住院 CAP 患儿临床特征的全面数据。我院经验性抗菌药物选择存在差异，突出了需要加强抗菌药物管理。
