Characterization of pediatric patients with necrotizing pneumonia treated at a quaternary care center in Bogotá, Colombia, 2010-2017

Abstract

Introduction: The incidence of Necrotizing Pneumonia (NP) as a complication of pneumonia has increased. Between 0.6 and 2% of parapneumonic effusions result in empyema, while up to 20% are complicated by necrosis. Methodology: A observational, ambispective study was conducted. The retrospective phase included patients treated between 2010 and 2015; the prospective between 2015 and 2017. The clinical records of patients with pneumonia were reviewed. Patients with pneumatoceles in radiography (Rx) or chest tomography (CT), or bronchopleural fistulas diagnosed were included. Results: 69 patients were collected. Information on immunization was obtained in 67% of patients. Laboratory test results showed leukocytosis > 15,000/mL (65%), thrombocytosis > 450,000/mL (45%), and LDH in pleural fluid > 2500 IU/L (61% of 18 patients). Imaging findings were consolidation (75% vs. 100%) and pneumatocele (33% vs 90%). Microbiological isolates were collected from 27 patients. Streptococcus pneumoniae (56%) and Staphylococcus aureus (30%) were the most common agents. Twelve (80%) pneumococci were identified: five serotype 3, two serotypes 14 and 19A, one serotypes 6A, 8, and 1. Conclusions: NP is a complication that should be suspected in children under 5 years of age with torpid evolution, leukocytosis, thrombocytosis, increased LDH levels in pleural fluid, and pneumatoceles in imaging scans.