Necrotizing pneumonia is an increasingly detected complication of pneumonia in children

¹ Division of Respiratory Diseases, Dept of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
² Clinical Research Program and Division of Gastroenterology and Nutrition, Dept of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA
³ Dept of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, MA

	Abstract

Necrotizing pneumonia (NP) is a severe complication of community acquired pneumonia characterized by liquefaction and cavitation of lung tissue. We describe the epidemiology, etiology, management, and outcomes of children hospitalized with NP over a 15-year period.

We conducted a retrospective observational study of NP cases from 1/1990 – 2/2005 analyzing clinical presentation, laboratory data, hospital course, and long-term follow-up.

Eighty (80) NP cases were identified, with the number of detected cases increasing from 12 during 1993–1996 to 40 during 2001–2004. Sixty-nine (69) cases (86%) had pleural effusion with a low pH (mean 7.08). Thirty-eight patients (48%) had positive cultures, with S. pneumoniae as the predominant organism. Recently, other organisms, most notably MRSA, emerged. Patients had prolonged hospitalizations (median 12 days). Sixty-nine 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.

We have increasingly identified NP as a complication of paediatric pneumonia. S. 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 hospitalizations, long-term outcome following NP is excellent.

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