Abdelhady Salma, A Moharram Amira, Fawzy Zainab, Fouda Eman
Department of Paediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Paediatric Respiratory department, Children's Hospital, Ain Shams University Hospitals, Cairo, Egypt.
Respir Res. 2025 Jul 2;26(1):235. doi: 10.1186/s12931-025-03291-w.
Incidence of childhood complicated community acquired pneumonia (cCAP) is increasing worldwide. Necrotising pneumonia (NP), empyema and complicated parapneumonic effusion (CPPE) are the most common local complications.
This retrospective observational study describes clinical characteristics, aetiology and management of children hospitalized with cCAP in one of the largest tertiary centers in Egypt, over 5 years (December 2017 till September 2022).
A total of 158 cases were identified. Seasonal variation was observed, as more cases were hospitalized during Winter and Spring. NP, empyema and CPPE, were diagnosed in 85 (54%), 52 (33%) and 21 (13%) children, respectively. 54 (64%) of children presented with NP had associated empyema or CPPE. The yield of pleural fluid, sputum and blood cultures were 23%, 18% and 17%, respectively. Community acquired MRSA was the predominant causative organism, followed by S pneumoniae. 87% of the patients had pleural interventions. 29 (18%) children received fibrinolytics. Three children presented with CAP and highly septated effusion, developed NP and persistent air leaks following fibrinolytic administration. Patients had prolonged hospitalization (median 17 days). 15 (10%) children had surgery. Children presented with NP had more morbidities and longer length of hospital stay, compared to children presented with CPPE and empyema. ICU admission, mechanical ventilation, severe anemia requiring blood transfusion, broncho-pleural fistula and surgical interventions were significantly higher in NP cohort. We report 5 mortalities, 4 of them below 1 year of age.
This study describes the largest cohort of children hospitalized with cCAP from Egypt till this date. Management of cCAP remains challenging worldwide and the current guidelines requires updating. Improvement of microbial detection and reporting is needed to promote antimicrobial stewardship.
儿童复杂性社区获得性肺炎（cCAP）的发病率在全球范围内呈上升趋势。坏死性肺炎（NP）、脓胸和复杂性类肺炎性胸腔积液（CPPE）是最常见的局部并发症。
这项回顾性观察研究描述了埃及最大的三级中心之一在5年期间（2017年12月至2022年9月）因cCAP住院儿童的临床特征、病因及治疗情况。
共确定了158例病例。观察到有季节变化，冬季和春季住院病例更多。分别有85例（54%）、52例（33%）和21例（13%）儿童被诊断为NP、脓胸和CPPE。患有NP的儿童中有54例（64%）伴有脓胸或CPPE。胸腔积液、痰液和血培养的阳性率分别为23%、18%和17%。社区获得性耐甲氧西林金黄色葡萄球菌是主要致病菌，其次是肺炎链球菌。87%的患者接受了胸腔干预。29例（18%）儿童接受了纤溶药物治疗。3例患有CAP和高度分隔胸腔积液的儿童，在接受纤溶药物治疗后发生了NP和持续性气胸。患者住院时间延长（中位时间17天）。15例（10%）儿童接受了手术。与患有CPPE和脓胸的儿童相比，患有NP的儿童有更多的并发症和更长的住院时间。NP组的重症监护病房入住率、机械通气、需要输血的严重贫血、支气管胸膜瘘和手术干预显著更高。我们报告了5例死亡病例，其中4例年龄在1岁以下。
本研究描述了迄今为止埃及因cCAP住院儿童的最大队列。cCAP的管理在全球范围内仍然具有挑战性，当前指南需要更新。需要改进微生物检测和报告以促进抗菌药物管理。
