Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.
Hosp Pediatr. 2021 Mar;11(3):207-214. doi: 10.1542/hpeds.2020-001800. Epub 2021 Feb 12.
To assess the characteristics of children hospitalized with complicated pneumonia at US children's hospitals and compare these characteristics with those of children hospitalized with community-acquired pneumonia (CAP).
We identified children hospitalized with complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess) or CAP across 34 hospitals between 2011 and 2019. We evaluated differences in patient characteristics, antibiotic selection, and outcomes between children with complicated pneumonia and CAP. We, also, assessed seasonal variability in the frequency of these 2 conditions and evaluated the prevalence of complicated pneumonia over the 9-year study period.
Compared with children hospitalized with CAP ( = 75 702), children hospitalized with complicated pneumonia ( = 6402) were older (a median age of 6.1 vs 3.4 years; < .001), with 59.4% and 35.2% of patients ≥5 years of age, respectively. Patients with complicated pneumonia had higher rates of antibiotic therapy targeted against methicillin-resistant (46.3% vs 12.2%; < .001) and (8.6% vs 6.7%; < .001), whereas differences in rates of coverage against mycoplasma were not clinically significant. Children with complicated pneumonia had a longer median hospital length of stay and higher rates of ICU admissions, mechanical ventilation, 30-day readmissions, and costs. Seasonal variation existed in both complicated pneumonia and CAP, with 42.7% and 46.0% of hospitalizations occurring during influenza season. The proportion of pneumonia hospitalizations due to complicated pneumonia increased over the study period (odds ratio 1.04, 95% confidence interval: 1.02-1.06).
Complicated pneumonia more frequently occurs in older children and accounts for higher rates of resource use, compared to CAP.
评估美国儿童医院住院治疗的复杂性肺炎患儿的特征，并将这些特征与社区获得性肺炎（CAP）患儿进行比较。
我们在 2011 年至 2019 年间，确定了 34 家医院中因复杂性肺炎（类肺炎性胸腔积液、脓胸、坏死性肺炎或肺脓肿）或 CAP 住院的儿童。我们评估了复杂性肺炎和 CAP 患儿在患者特征、抗生素选择和结局方面的差异。我们还评估了这两种疾病在频率上的季节性差异，并评估了在 9 年研究期间复杂性肺炎的流行情况。
与 CAP 住院患儿（n=75702）相比，复杂性肺炎住院患儿（n=6402）年龄更大（中位数年龄为 6.1 岁 vs 3.4 岁；<0.001），分别有 59.4%和 35.2%的患者年龄≥5 岁。复杂性肺炎患儿接受针对耐甲氧西林金黄色葡萄球菌（46.3% vs 12.2%；<0.001）和耐青霉素肺炎链球菌（8.6% vs 6.7%；<0.001）的抗生素治疗的比例更高，而针对支原体的覆盖范围差异无临床意义。复杂性肺炎患儿的中位住院时间更长，入住 ICU、机械通气、30 天再入院和费用的比例更高。复杂性肺炎和 CAP 均存在季节性变化，分别有 42.7%和 46.0%的住院发生在流感季节。在研究期间，因复杂性肺炎导致的肺炎住院比例增加（比值比 1.04，95%置信区间：1.02-1.06）。
与 CAP 相比，复杂性肺炎更常发生在年龄较大的儿童中，且需要更高的资源利用率。
