23C / 88– INCIDENCE OF COMPLICATED PNEUMONIA IN BELGIAN CHILDREN AND CLINICAL
EVOLUTION UNDER CONSERVATIVE MANAGEMENT.
P Van De Wijdeven, B Gijsen, F Vermeulen, K De Boeck, M Proesmans.
UZ Gasthuisberg Pediatric Pulmonology – Leuven, Belgium
Introduction The incidence and outcome of complicated pneumonia (CP) in our institution were studied In
a previous retrospective study from 1993 until 2005. Disease characteristics and treatment modalities were
also reported (Van Ackere et al 2009). Aim prospective follow-up of children with CP treated according to a
standardized treatment plan. Methods Since may 2006, children admitted with CP in the University
Hospital of Leuven, Belgium are registered prospectively and treatment decisions are taken according to a
standardized algorithm (Proesmans M et al EJP): antibiotics, chest drain (Seldinger technique) with
intrapleural Urokinase® if empyema; surgical treatment if medical treatment fails. CP was defined as at
least one of the following 1) loculated effusion on US or CT, 2) analysis of pleural fluid compatible with
empyema or 3) need for drain, VATS or thoracotomy. Necrotizing pneumonia was defined as signs of
liquefaction and cavitation on chest X ray and/or CT.
Results Forty nine patients were registered over a period of 2.5 years. The number of patients treated per
year was 19-20 from 1-10-2007 to to 30-09-2009 compared to 11-12/year in the years 2003 to 2005. The
median patient age was 3.6 years (IQR 2.7-4.8), 34 male/15 female . Only 4 patients had additional
medical problems (2 asthma, 1 VSD and lobectomy, 1 mental retardation) and 34 patient were referred
after a median admission of 6 days (IQR 3-8.75). The median duration of fever before first hospital
admission was 4 days(IQR 2-6).
A causative agent was detected by blood culture in 11/43 sampled patients (all S pneumonia) and in 0/31
by pleural culture. All but 4 patients had been treated with antibiotics before referral. Twenty six of 49
patients were treated with antibiotics only. For 21 patients a chest drain was placed, of which 14 were
treated with Urokinase©. VATS was performed in 3 (1 primary, 1 failure of drain, 1 failure of drain +UK) and
3 patients had a thoracotomy (1 primary and 2 after drain +UK). Twelve patients developed a necrotizing
pneumonia (2 with lung abscess, 2 with bronchopleural fistula and 6 with pneumatocele), of which only 1
patient underwent a lung resection (segmentectomy). The median hospital stay in our center was 10 days
(IQR 5-16) with a total hospital duration of 17 (IQR 13-24).
Conclusion Since 2003-2005 the incidence of CP in our center increased further. Following a treatment
algorithm with medical treatment as first step, failure rate and need for surgical intervention was low. Even
in case of necrotizing pneumonia, prognosis is good; lung resection only had to be performed in 1 patient.
Total hospital stay had decreased compared to our previous report.