Pediatric Community-Acquired Pneumonia
Key Points
Key Points
In the developed world, the annual incidence of pneumonia is approximately 3-4 cases per 100 children younger than 5 years. Incidence varies inversely with age.
Vaccines have dramatically decreased the incidence of infections, including community-aquired pneumonia (CAP).
Pathogens responsible for "atypical pneumonia" have been identified in 3% to 23% of children studied, with Mycoplasma pneumoniae more often identified in older children.
Viral etiologies of CAP have been documented in up to 80% of children younger than 2 years. In contrast, investigations of older children, 10-16 years, who had both clinical and radiographic evidence of pneumonia, documented a much lower percentage of viral pathogens.
Respiratory syncytial virus (RSV) is consistently the most frequently detected virus, representing up to 40% of identified pathogens in those younger than 2 years, but rarely identified in older children with CAP. Less frequently detected are adenoviruses, bocavirus, human metapneumovirus, influenza A and B viruses, parainfluenza viruses, coronaviruses and rhinovirus.
Diagnosis and Assessment
...agnosis and Assessment...
...Care Management Decisions...
...spital
...infants who have moderate to severe CAP2 as...
...ants 3-6 months of age with suspected bacterial...
...hildren and infants with a suspicion or docu...
...fants for whom there is concern about careful...
Intensive Care...
...uld be admitted to an intensive care unit...
...d should be admitted to an ICU or a...
...hould be admitted to an ICU or a unit wit...
...child should be admitted to an ICU or a uni...
...ould be admitted to an ICU if pulse oximetry i...
...be admitted to an ICU or a unit with con...
Severity of illness scores should NOT...
...stic Testing
...iologic Testing
...od Cultures: Outpatient...
...should NOT be routinely performed in...
...ultures should be obtained in children who...
Blood Cultures: Inpat...
...ood cultures should be obtained in children...
...ients who otherwise meet criteria for dis...
...llow-up Blood Cultures...
...eat blood cultures in children with cl...
...blood cultures to document resolution of bacte...
...Gram Stain and Culture...
...utum samples for culture and Gram stain s...
...tigen Detection Tests...
...ntigen detection tests are NOT recom...
...sting For Viral Pat...
...ive and specific tests for the rapid...
...tibacterial therapy is not necessary for children...
...for respiratory viruses other than influenza vir...
...g for Atypical Bacteria...
...gns and symptoms suspicious for M. pn...
...testing for Chlamydophila pneumoniae...
...illary Diagnostic Testing...
...omplete Blood Co...
...ent of the complete blood count is NOT necessary i...
...complete blood count should be obtained for patie...
...te-Phase Reactan...
...te-phase reactants such as the erythr...
...phase reactants need not be routinely measured in...
...ts with more serious disease such as those re...
Pulse Oxime...
...try should be performed on all childre...
...est Radiogra...
...al Chest Radiographs: Outpa...
...tine chest radiographs are not necessary...
...aphs, posteroanterior (PA) and later...
...est Radiographs: Inpatien...
...st radiographs (PA and lateral) should b...
...-up Chest Radiograph...
...hest radiographs are not routinely required in ch...
...peat chest radiograph should be obtained in chil...
...y chest radiography is NOT recommende...
...ow-up chest radiographs should be ob...
...diographs 4-6 weeks after the diagnosis of C...
...or Life-Threatening CAP...
...should obtain tracheal aspirates for Gram stain...
...c or blind protected specimen brush samp...
...Complications Associated With CAPH...
...2. Criteria for Respiratory DistressH...
...a for CAP Severity of IllnessaHaving tro...
Prevention
...eventio...
...be immunized with vaccines for bacterial...
...adolescents 6 months of age and older should...
...nd caretakers of infants less than s...
...neumococcal CAP following influenza virus...
...igh-risk infants should be provided immune...
...Selection of Antimicrobial Therapy for Spe...
Treatment
...atment
...-infective...
Outpatie...
...ial therapy is not routinely required for prescho...
...ould be used as first-line therapy for previous...
...should be used as first-line therapy for previo...
...acrolide antibiotics should be prescribed f...
...ral therapy (Table 5) should be administere...
...atient...
...or penicillin G should be administered to t...
...apy with a third generation parentera...
...iric combination therapy with a macrolide (o...
...clindmycin (based on local susceptibili...
...zing Resistance
...ure selects for antibiotic resistance....
...spectrum of activity of antimicrobials to that...
...er dosage of antimicrobial to be able to achie...
...the shortest effective duration w...
...f Antimicrobial Therapy...
...es of 10 days have been best studied, although sho...
...aused by certain pathogens, notably CA-MRS...
...low-up...
...ren on adequate therapy should demonstrate cl...
...e Surgical and Non–Anti-infective The...
Parapneumonic Eff...
...story and physical examination may...
...size of the effusion is an important fact...
...he child’s degree of respiratory compr...
...bacterial culture of pleural fluid should be perfo...
...testing or nucleic acid amplification...
...leural fluid parameters such as pH, gluc...
...is of the pleural fluid white blood cell count...
...complicated parapneumonic effusions shou...
...oderate parapneumonic effusions associated with r...
...acostomy tube drainage with the addition of fibrin...
VATS should be performed when there is persistenc...
...chest tube can be removed in the ab...
...py for Parapneumonic Effusion/Empyema...
...the blood or pleural fluid bacterial cultu...
...f culture-negative parapneumonic effusions,...
...uration of antibiotic treatment de...
...response
...linical and laboratory assessment to...
...evaluation to assess the extent and p...
...ation to identify whether the original pathoge...
...cimen should be obtained for Gram stain and cult...
...neous lung aspirate should be obtained for Gra...
An open lung biopsy for Gram stain...
...abscess or necrotizing pneumonia iden...
...ischarge Criteria
...ts are eligible for discharge when t...
...ligible for discharge when they demonstrate cons...
...tients are eligible for discharge only...
...not eligible for discharge if they have su...
...s should have documentation that they can tolerat...
...r young children requiring outpatient oral...
...hildren who have had a chest tube and meet the r...
...fants and children with barriers to ca...
...for Parenteral Outpatient Therapy...
...parenteral antibiotic therapy should be offered t...
...nteral antibiotic therapy should be offered throug...
...to oral outpatient step-down therapy is preferre...
...able 5. Influenza Antiviral Therap...
...mpiric Therapy for Pediatric CAPHaving tr...
...e 7. Factors Associated with Outcomes and...
...ment of Pneumonia with Parapneumonic Effusion...
...8. Available AntibacterialsHaving troubl...