Globally, the incidence of community-acquired pneumonia (CAP) has decreased by almost a third and the mortality rate has been cut in half since the year 2000. These reductions are due, in large part, to the deployment of improved pneumococcal conjugate vaccines in recent years. Despite this progress, CAP remains a leading cause of mortality worldwide and many patients still suffer from its complications, such as parapnemonic effusion and empyema. While knowing the factors associated with the development of complicated pneumonia could theoretically guide our evaluation and treatment, these factors have not been well described.

In this month’s issue of Hospital Pediatrics(10.1542/hpeds.2020-001800), Gross et al provides some clarity to this question by comparing characteristics of children admitted for CAP and complicated pneumonia using a large database of US children’s hospitals. Over a 9-year period, this study included over 82,000 discharges of pediatric patients diagnosed with CAP or complicated pneumonia from 34 free-standing children’s hospitals participating in the Pediatric Health Information System. Hospitals provided discharge-level data, including patient demographics, hospital characteristics, and diagnostic and procedure codes. The authors found that, compared to children hospitalized with CAP, children hospitalized with complicated pneumonia were significantly older (median age 6.1 years vs 3.4 years), white, privately insured, and more likely to have an underlying complex chronic condition. Those with complicated pneumonia also utilized more resources (e.g., pharmaceuticals, imaging, labs, critical care), were hospitalized longer, and had higher hospital costs and 30-day readmission rates.

Perhaps the most interesting finding in this study was the significant variation in antibiotic prescribing patterns for each diagnosis. Data collection started right as the most recent Infectious Disease Society of America guidelines for CAP management were being published in 2011; it is unknown whether participating hospitals started to follow them after publication. National efforts to adopt guideline recommended, narrow-spectrum antibiotic regimens for CAP have shown promise^1,2 and remain an important area for investigation.

References:

1. Williams DJ, Hall M, Gerber JS, et al. Impact of a National Guideline on Antibiotic Selection for Hospitalized Pneumonia. Pediatrics. 2017;139(4):e20163231
2. Parikh K, Biondi E, Nazif J, et al. A Multicenter Collaborative to Improve Care of Community Acquired Pneumonia in Hospitalized Children. Pediatrics. 2017;139(3):e20161411