Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Microbiol Immunol Infect. 2015 Feb;48(1):36-42. doi: 10.1016/j.jmii.2013.06.009. Epub 2013 Aug 28.
Complications regarding pneumonia occur in children during hospitalization and treatment. The objective of this study is to identify the risk factors of progressive pneumonia in order to institute early appropriate therapy.
This was a prospective study which involved the pediatric departments of seven medical centers in Taiwan. Children aged from 6 weeks to 18 years old, hospitalized with community-acquired pneumonia (CAP) from January 2010 to August 2011, were enrolled. Progressive pneumonia was defined by the deterioration of discharge diagnosis as compared to admission. Demographic, clinical, and laboratory variables, diagnosis, antimicrobial therapy, and pathogens were compared.
Four hundred and two children were included and 57 (14.2%) had progressive pneumonia. Independent associated factors identified for the development of progressive disease, by multivariate logistic regression analysis, included the following, age < 2 years, pleural effusion as admission diagnosis, Hb < 10 g/dL, WBC count > 17,500/μL, tachypnea, and duration to defervescence > 3 days. Streptococcus pneumoniae was the main etiology for progressive pneumonia (57.9%). There was no difference in choice of initial parenteral antibiotics between groups of progressive and non-progressive pneumococcal pneumonia.
We found six clinical factors for predicting progressive pneumonia. Further evaluation should be performed in hospitalized pneumonic children with persistent fever not responding to therapy within 72 hours. The initial parenteral antibiotics were not related to the progression of pneumococcal pneumonia.
肺炎在儿童住院和治疗期间会出现并发症。本研究旨在确定肺炎进展的危险因素，以便早期进行适当的治疗。
这是一项前瞻性研究，涉及台湾 7 家医疗中心的儿科部门。2010 年 1 月至 2011 年 8 月期间，患有社区获得性肺炎（CAP）的 6 周至 18 岁住院儿童被纳入研究。肺炎进展的定义是与入院时相比出院诊断恶化。比较了人口统计学、临床和实验室变量、诊断、抗菌治疗和病原体。
共纳入 402 名儿童，其中 57 名（14.2%）患有进展性肺炎。多变量逻辑回归分析确定的进展性疾病的独立相关因素包括年龄<2 岁、入院时胸腔积液诊断、Hb<10 g/dL、白细胞计数>17,500/μL、呼吸急促和退热时间>3 天。肺炎链球菌是进展性肺炎的主要病因（57.9%）。进展性和非进展性肺炎链球菌肺炎组在初始静脉用抗生素的选择上无差异。
我们发现了 6 个预测肺炎进展的临床因素。对于持续发热且治疗 72 小时后仍未退热的住院肺炎患儿，应进一步评估。初始静脉用抗生素与肺炎链球菌肺炎的进展无关。
