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- 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.
- Annual incidence estimated to be 14.9 to 16.5/10,000 children in the United States
- Highest incidence in children <2 years of age (57.6 to 67.1/10,000)
- 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
- Smoke exposure
Routine vaccination (e.g., PCV13, Haemophilus influenzae type b [Hib], DTaP)
- 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.