Variation in Management and Outcomes of Children With Complicated Pneumonia

Abstract

OBJECTIVES: To assess the characteristics of children hospitalized with complicated pneumonia at US children’s hospitals and compare these characteristics with those of children hospitalized with community-acquired pneumonia (CAP). METHODS: We identified children hospitalized with complicated pneumonia (parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess) or CAP across 34 hospitals between 2011 and 2019. We evaluated differences in patient characteristics, antibiotic selection, and outcomes between children with complicated pneumonia and CAP. We, also, assessed seasonal variability in the frequency of these 2 conditions and evaluated the prevalence of complicated pneumonia over the 9-year study period. RESULTS: Compared with children hospitalized with CAP (n = 75 702), children hospitalized with complicated pneumonia (n = 6402) were older (a median age of 6.1 vs 3.4 years; P < .001), with 59.4% and 35.2% of patients ≥5 years of age, respectively. Patients with complicated pneumonia had higher rates of antibiotic therapy targeted against methicillin-resistant Staphylococcus aureus (46.3% vs 12.2%; P < .001) and Pseudomonas (8.6% vs 6.7%; P < .001), whereas differences in rates of coverage against mycoplasma were not clinically significant. Children with complicated pneumonia had a longer median hospital length of stay and higher rates of ICU admissions, mechanical ventilation, 30-day readmissions, and costs. Seasonal variation existed in both complicated pneumonia and CAP, with 42.7% and 46.0% of hospitalizations occurring during influenza season. The proportion of pneumonia hospitalizations due to complicated pneumonia increased over the study period (odds ratio 1.04, 95% confidence interval: 1.02–1.06). CONCLUSIONS: Complicated pneumonia more frequently occurs in older children and accounts for higher rates of resource use, compared to CAP.

Disease Severity and Risk Factors of 30-Day Hospital Readmission in Pediatric Hospitalizations for Pneumonia

“…Our analysis demonstrated an association between longer length of stay and risk of readmission, as supported by a similar study of children with complicated pneumonia [ 39 ]. Contrary to our findings, other observational studies of pediatric readmissions in U.S. children’s hospitals found no meaningful association between index hospitalization length of stay and risk of readmission in children’s hospitals [ 40 , 41 ].…”

Disease Severity and Risk Factors of 30-Day Hospital Readmission in Pediatric Hospitalizations for Pneumonia

“…Our analysis demonstrated an association between longer length of stay and risk of readmission, as supported by a similar study of children with complicated pneumonia [39]. Contrary to these findings, other observational studies of pediatric readmissions in U.S. children's hospitals found no meaningful association between index hospitalization length of stay and risk of readmission in children's hospitals [40,41].…”

Inpatient outcomes for children receiving empiric methicillin‐resistant Staphylococcus aureus coverage for complicated pneumonia

“…Gross et al previously reported that children hospitalized with complicated pneumonia were more likely to receive MRSA antibiotics than patients with CAP 3 . In our study, we observed an association between empiric MRSA coverage and increased rate of transfer to the ICU, need for mechanical ventilation, and higher H‐RISK score.…”

“…Up to 40% of children hospitalized with bacterial pneumonia will develop complicated pneumonia, defined as the development of a parapneumonic effusion/empyema 2 . Compared to children with uncomplicated pneumonia, those with a complicated pneumonia commonly require increased procedural interventions, are more frequently exposed to broad‐spectrum antibiotics, and have prolonged hospitalizations 3 . While the prevalence of bacterial pneumonia has overall declined with routine childhood vaccination, the number of children with complicated disease has remained stable, highlighting the need to identify treatment strategies that optimize care for these patients 1,3 …”