Krenke Katarzyna, Sanocki Marcin, Urbankowska Emilia, Kraj Grażyna, Krawiec Marta, Urbankowski Tomasz, Peradzyńska Joanna, Kulus Marek
Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warszawa, Poland.
Adv Exp Med Biol. 2015;857:9-17. doi: 10.1007/5584_2014_99.
Necrotizing pneumonia (NP) is an emerging complication of community acquired pneumonia (CAP) in children. This study aimed at the evaluation of etiology, clinical features, treatment, and prognosis of NP. The institutional database of children with CAP treated between April 2008 and July 2013 was searched to identify children with NP. Then, data on the NP characteristics were retrospectively reviewed and analyzed. We found that NP constituted 32/882 (3.7%) of all CAPs. The median age of children with NP was 4 (range 1-10) years. The causative pathogens were identified in 12/32 children (37.5%) with Streptococcus pneumoniae being the most common (6/32). All but one patient developed complications: parapneumonic effusion (PPE), pleural empyema or bronchopleural fistula (BPF), which required prompt local treatment. The median duration of hospital stay and antibiotic treatment was 26 (IQR 21-30) and 28 (IQR 22.5-32.5) days, respectively. Despite severe course of the disease no deaths occurred. A follow-up visit after 6 months revealed that none of the patients presented with any signs and symptoms which could be related to earlier pneumonia. Chest radiographs showed complete or almost complete resolution of pulmonary and pleural lesions in all patients. We conclude that necrotizing pneumonia is a relatively rare but severe form of CAP that is almost always complicated by PPE/empyema and/or BPF. It can be successfully treated with antibiotics and pleural drainage without major surgical intervention.
坏死性肺炎（NP）是儿童社区获得性肺炎（CAP）的一种新出现的并发症。本研究旨在评估NP的病因、临床特征、治疗及预后。检索了2008年4月至2013年7月期间接受治疗的CAP患儿的机构数据库，以确定患有NP的儿童。然后，对NP特征的数据进行回顾性审查和分析。我们发现NP占所有CAP的32/882（3.7%）。NP患儿的中位年龄为4岁（范围1 - 10岁）。在32例患儿中有12例（37.5%）确定了致病病原体，其中肺炎链球菌最为常见（6/32）。除1例患者外，所有患者均出现并发症：肺炎旁胸腔积液（PPE）、胸膜腔积脓或支气管胸膜瘘（BPF），这需要及时进行局部治疗。住院时间和抗生素治疗的中位时长分别为26天（四分位间距21 - 30天）和28天（四分位间距22.5 - 32.5天）。尽管疾病过程严重，但无死亡发生。6个月后的随访显示，没有患者出现任何可能与早期肺炎相关的体征和症状。胸部X线片显示所有患者的肺部和胸膜病变完全或几乎完全消退。我们得出结论，坏死性肺炎是CAP一种相对罕见但严重的形式，几乎总是并发PPE/胸膜腔积脓和/或BPF。通过抗生素和胸腔引流可成功治疗，无需进行重大手术干预。
