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Necrotising pneumonia is an increasingly detected complication of pneumonia in children

¹ Division of Respiratory Diseases, Dept of Medicine, ² Clinical Research Program and Division of Gastroenterology and Nutrition, Dept of Medicine, ³ Dept of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA, ⁴ Both authors contributed equally to this study.

CORRESPONDENCE: G. Sawicki, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115USA. Fax: 1 6177300097. E-mail: gregory.sawicki{at}childrens.harvard.edu

Keywords: Cavitatory pneumonia, empyema, necrotising pneumonia, pleural effusion, pneumonia

Received: August 3, 2007
Accepted January 10, 2008

Necrotising pneumonia (NP) is a severe complication of community-acquired pneumonia characterised by liquefaction and cavitation of lung tissue. The present study describes the epidemiology, aetiology, management and outcomes of children hospitalised with NP over a 15-yr period.

A retrospective observational study of NP cases was conducted from January 1990 to February 2005 analysing clinical presentation, laboratory data, hospital course and long-term follow-up.

A total of 80 NP cases were identified, with the number of detected cases increasing from 12, in the period 1993–1996, to 40 in the period 2001–2004. In total, 69 (86%) cases had pleural effusion with a low pH (mean 7.08) and 38 (48%) patients had positive cultures, with Streptococcus pneumoniae as the predominant organism. Recently, other organisms, most notably methicillin-resistant Staphylococcus aureus, emerged. Patients had prolonged hospitalisations (median 12 days). A total of 69 patients required pleural interventions and those receiving chest drainage alone had similar outcomes to those managed surgically. All patients had full clinical resolution within 2 months of presentation.

Necrotising pneumonia has increasingly been identified as a complication of paediatric pneumonia. Streptococcus pneumoniae remains the predominant organism, but since 2002, different bacteria have been isolated and the age range of cases has broadened. Despite the serious morbidity, massive parenchymal damage and prolonged hospitalisations, long-term outcome following necrotising pneumonia is excellent.

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