• 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)

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 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.

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