Description

• Pneumonia is an infection of the lungs involving the alveoli and distal airways.
• Complicated pneumonia implies pneumonia with: effusion/empyema, abscesses, multilobar disease, necrosis, fistulae, or multisystem infection
• Although viral pneumonias still generally comprise a large proportion of pediatric pneumonia, this chapter focuses on bacterial etiologies and treatment.

Epidemiology

Risk Factors

• Immune deficiency
  • Immunocompromised status
  • Sickle cell anemia
• Increased aspiration risk
  • Altered mental status
  • Tracheoesophageal fistula
  • Cerebral palsy
  • Seizure disorder
• Compromised lung function/anatomy
  • Cystic fibrosis
  • Congenital pulmonary malformations
  • Bronchopulmonary dysplasia
  • Asthma
  • Smoke exposure

General Prevention

Routine vaccination (e.g., PCV13, Haemophilus influenzae type b [Hib], DTaP)

Etiology

• Etiology of bacterial pneumonia differs by age:
  • Neonates: group B Streptococcus, enteric gram-negative rods (e.g., Escherichia coli), Listeria monocytogenes, H. influenzae, Bordetella pertussis
  • 1 to 3 months: neonate organisms + Staphylococcus aureus, Streptococcus pneumoniae, Chlamydia trachomatis
  • 4 months to 4 years: Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Mycoplasma pneumoniae, H. influenzae
  • >5 years of age: Staphylococcus pneumoniae, M. pneumoniae, Staphylococcus aureus, H. influenzae, Chlamydophila pneumoniae, Mycobacterium tuberculosis
• Etiology can also differ based on risk factors:
  • Aspiration as etiology increases the risk for oral flora including anaerobes such as Bacteroides and Peptostreptococcus
  • Ventilator-dependent patients are at increased risk for Pseudomonas or Klebsiella infections and infection with other gram-negative rods.
  • Cystic fibrosis increases the risk for Pseudomonas and other more unusual organisms as well as drug-resistant bacteria.