ntroduction: Up to 9% of community-acquired pneumonia (CAP) cases in children may progress to a complicated form (cCAP), including necrotizing pneumonia, pleural effusion, empyema, or lung abscess. These conditions are associated with a prolonged clinical course and may require a multidisciplinary medical and surgical approach. Objectives: The primary objective of the study was to describe the clinical course, trends in the main biochemical markers, diagnostic investigations, antibiotic therapy, and any surgical interventions in patients with cCAP. Secondary objectives were to identify, through the analysis of baseline clinical, radiological, and biochemical data, potential predictors of greater disease severity and to assess long-term clinical, radiological, and functional outcomes. Materials and Methods: All patients admitted for cCAP to the Department of Women’s and Children’s Health of the University Hospital of Padua between October 2024 and June 2026 were included. Patients were evaluated at admission (T0) and at predefined time points up to 60 days, with collection of medical history, clinical, laboratory, microbiological, radiological, and therapeutic data. Results: During the study period, 166 children were admitted for pneumonia, of whom 14 (8.4%) had cCAP. Most patients were male and aged ≤5 years; 64.3% presented with necrotizing pneumonia associated with empyema, while 35.7% had isolated pleural effusion. The clinical course was characterized by prolonged fever, with a median duration of 14 days, and a median hospital stay of 13 days. All patients showed a marked inflammatory response, with median peak CRP and PCT levels of 306.85 mg/L and 15.35 µg/L, respectively; anemia, thrombocytosis, and hypoalbuminemia were also frequent. A bacterial pathogen was identified in only a limited proportion of cases, whereas viral PCR testing of nasopharyngeal aspirates or bronchoaspirates was positive in 71.4% of patients. Necrotizing pneumonia was diagnosed by lung ultrasound in 44.5% of cases, CT in 33%, and chest X-ray in 22%. Regression analysis showed an association between longer fever duration and older age, a greater number of affected lobes, hypoalbuminemia, and leukocytosis at admission, identifying these parameters as potential predictors of greater disease severity. All patients received prolonged intravenous antibiotic therapy; 57.1% required respiratory support and the same proportion underwent chest tube drainage, with intrapleural urokinase administration in 75% of drained cases. No patient required invasive surgery, and no deaths occurred. At follow-up, all patients were clinically asymptomatic, with radiological normalization in most cases and respiratory function within normal limits in the children who could be assessed. Conclusions: Pediatric cCAP is characterized by a prolonged clinical course and a marked inflammatory response, but generally has a favorable outcome when managed promptly through a multidisciplinary approach. Age, extent of pulmonary involvement, hypoalbuminemia, and leukocytosis may represent useful indicators of disease severity already at admission. Multidisciplinary coordination of diagnostic and therapeutic pathways may help reduce the use of unnecessary investigations and treatments. Multicenter studies and longer follow-up are needed to confirm these findings.
Introduzione: Fino al 9% delle polmoniti acquisite in comunità (CAP) in età pediatrica può evolvere verso una forma complicata (cCAP), comprendente polmonite necrotizzante, versamento pleurico, empiema o ascesso polmonare. Queste condizioni sono associate a un decorso prolungato e possono richiedere un approccio multidisciplinare medico-chirurgico. Obiettivi: Obiettivo primario dello studio è stato descrivere il decorso clinico, l’andamento dei principali marcatori bioumorali, gli accertamenti diagnostici, la terapia antibiotica e gli eventuali interventi chirurgici nei pazienti con cCAP. Obiettivi secondari sono stati identificare, mediante l’analisi dei dati clinici, radiologici e bioumorali al baseline, possibili fattori predittivi di maggiore severità e valutare gli esiti clinici, radiologici e funzionali a distanza. Materiali e metodi: Sono stati inclusi tutti i pazienti ricoverati per cCAP presso il Dipartimento di Salute Donna e Bambino dell’Azienda Ospedale-Università di Padova tra ottobre 2024 e giugno 2026. I pazienti sono stati valutati al ricovero (T0) e a intervalli prestabiliti fino a 60 giorni, raccogliendo dati anamnestici, clinici, laboratoristici, microbiologici, radiologici e terapeutici. Risultati: Nel periodo di studio sono stati ricoverati 166 bambini per polmonite, di cui 14 (8,4%) con cCAP. La maggior parte era di sesso maschile e di età ≤5 anni; il 64,3% presentava polmonite necrotizzante associata a empiema e il 35,7% versamento pleurico isolato. Il decorso era caratterizzato da febbre prolungata, con durata mediana di 14 giorni, e degenza mediana di 13 giorni. Tutti i pazienti presentavano una marcata risposta infiammatoria, con valori mediani di picco di PCR pari a 306,85 mg/L e PCT pari a 15,35 µg/L; frequenti erano inoltre anemia, piastrinosi e ipoalbuminemia. Un patogeno batterico è stato identificato solo in una quota limitata di casi, mentre la PCR virale su aspirato nasofaringeo o broncoaspirato è risultata positiva nel 71,4% dei pazienti. La polmonite necrotizzante è stata diagnosticata mediante ecografia polmonare nel 44,5% dei casi, TC nel 33% e radiografia del torace nel 22%. L’analisi di regressione ha evidenziato un’associazione tra maggiore durata della febbre e maggiore età, numero di lobi coinvolti, ipoalbuminemia e leucocitosi al ricovero, identificando tali parametri come potenziali predittori di maggiore severità. Tutti i pazienti hanno ricevuto antibioticoterapia endovenosa prolungata; il 57,1% ha necessitato di supporto respiratorio e altrettanti di drenaggio toracico, con instillazione intrapleurica di urochinasi nel 75% dei casi drenati. Nessun paziente ha richiesto chirurgia invasiva e non si sono verificati decessi. Al follow-up, tutti i pazienti risultavano clinicamente asintomatici, con normalizzazione radiologica nella maggior parte dei casi e funzionalità respiratoria nei limiti della norma nei bambini valutabili. Conclusioni: La cCAP pediatrica presenta un decorso prolungato e una marcata risposta infiammatoria, ma un esito generalmente favorevole se gestita precocemente mediante un approccio multidisciplinare. Età, estensione del coinvolgimento polmonare, ipoalbuminemia e leucocitosi possono rappresentare utili indicatori di severità già al ricovero. La condivisione multidisciplinare dei percorsi diagnostico-terapeutici può contribuire a limitare il ricorso a indagini e trattamenti non necessari. Saranno necessari studi multicentrici e follow-up più prolungati per confermare questi risultati.
POLMONITI COMPLICATE IN ETA’ PEDIATRICA: STUDIO PROSPETTICO IN UN CENTRO DI TERZO LIVELLO
SANTINI, MICAELA
2022/2023
Abstract
ntroduction: Up to 9% of community-acquired pneumonia (CAP) cases in children may progress to a complicated form (cCAP), including necrotizing pneumonia, pleural effusion, empyema, or lung abscess. These conditions are associated with a prolonged clinical course and may require a multidisciplinary medical and surgical approach. Objectives: The primary objective of the study was to describe the clinical course, trends in the main biochemical markers, diagnostic investigations, antibiotic therapy, and any surgical interventions in patients with cCAP. Secondary objectives were to identify, through the analysis of baseline clinical, radiological, and biochemical data, potential predictors of greater disease severity and to assess long-term clinical, radiological, and functional outcomes. Materials and Methods: All patients admitted for cCAP to the Department of Women’s and Children’s Health of the University Hospital of Padua between October 2024 and June 2026 were included. Patients were evaluated at admission (T0) and at predefined time points up to 60 days, with collection of medical history, clinical, laboratory, microbiological, radiological, and therapeutic data. Results: During the study period, 166 children were admitted for pneumonia, of whom 14 (8.4%) had cCAP. Most patients were male and aged ≤5 years; 64.3% presented with necrotizing pneumonia associated with empyema, while 35.7% had isolated pleural effusion. The clinical course was characterized by prolonged fever, with a median duration of 14 days, and a median hospital stay of 13 days. All patients showed a marked inflammatory response, with median peak CRP and PCT levels of 306.85 mg/L and 15.35 µg/L, respectively; anemia, thrombocytosis, and hypoalbuminemia were also frequent. A bacterial pathogen was identified in only a limited proportion of cases, whereas viral PCR testing of nasopharyngeal aspirates or bronchoaspirates was positive in 71.4% of patients. Necrotizing pneumonia was diagnosed by lung ultrasound in 44.5% of cases, CT in 33%, and chest X-ray in 22%. Regression analysis showed an association between longer fever duration and older age, a greater number of affected lobes, hypoalbuminemia, and leukocytosis at admission, identifying these parameters as potential predictors of greater disease severity. All patients received prolonged intravenous antibiotic therapy; 57.1% required respiratory support and the same proportion underwent chest tube drainage, with intrapleural urokinase administration in 75% of drained cases. No patient required invasive surgery, and no deaths occurred. At follow-up, all patients were clinically asymptomatic, with radiological normalization in most cases and respiratory function within normal limits in the children who could be assessed. Conclusions: Pediatric cCAP is characterized by a prolonged clinical course and a marked inflammatory response, but generally has a favorable outcome when managed promptly through a multidisciplinary approach. Age, extent of pulmonary involvement, hypoalbuminemia, and leukocytosis may represent useful indicators of disease severity already at admission. Multidisciplinary coordination of diagnostic and therapeutic pathways may help reduce the use of unnecessary investigations and treatments. Multicenter studies and longer follow-up are needed to confirm these findings.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/112929