Complications in community acquired pneumonia: magnitude of problem, risk factors, and management in pediatric age

ABSTRACT

Introduction

In the last decades, the large use of several effective vaccines has dramatically reduced the incidence of community acquired pneumonia (CAP) in infants and children. Moreover, the availability of new antibiotics effective against emerging resistant strains of bacteria has greatly improved the early and long-term prognosis of this disease.

Areas covered

The aim of this manuscript is to evaluate the burden of complicated CAP in pediatric age and to discuss its appropriate management.

Expert opinion

Complicated CAP remains a problem for children in industrialized and developing countries. A larger use of lung ultrasonography (US) as first diagnostic approach could significantly improve early identification of cases at higher risk of complications. Difficult to solve, is the problem of the use of an antibiotic therapy able to assure adequate control in all the CAP cases, including those at high risk of or with already established complications. All these findings reveal that control of the incidence of complicated CAP remains difficult and will not be significantly changed in the next few years. Any attempt to improve complicated CAP management must be made. Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.

KEYWORDS:

• Antibiotics
• community-acquired pneumonia
• lung ultrasonography
• Staphylococcus aureus
• vaccine

Article highlights

• Community-acquired pneumonia (CAP) remains one of the most common cause of pediatric morbidity and hospitalization worldwide

• Locally complicated CAPs, i.e. CAPs associated with parapneumonic effusion/empyema (PPE/EP), necrosis of lung parenchyma (NC), and lung abscess (AB), are among the cases whose incidence has been less affected by the most recent prophylactic and therapeutic measures and for which the risk of negative evolution remains significant worldwide.

• Lung ultrasonography (US) as first approach to CAP diagnosis could significantly improve early identification of CAP cases at higher risk of complications.

• The recommended therapy for CAP is initially based on the use of drugs that are generally ineffective against Staphylococcus aureus, a pathogen that plays a relevant role in the determination of complicated cases.

• Any attempt to improve complicated CAP management must be made and Consensus documents on better definition of the use of corticosteroids, fibrinolytic agents, and interventional procedures (including surgery) can allow us to reach this goal.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.