DIAGNOSTICS AND TREATMENT OF COMPLICATED COMMUNITY–ACQUIRED PNEUMONIA IN CHILDREN

Abstract

While the incidence of childhood pneumonia has declined because of introduced pneumococcal conjugate vaccines in various countries, population rates of severe complicated pneumonia have increased during the last two decades. Streptococcus pneumonia remains themost common causative pathogen of bacterial pneumonia, especially the serotypes that are not included in the vaccine. Complications of CAP in children can be divided into pulmonary and systemic. Themost common ones include parapneumonic pleural effusion, empyema, abscess, necrotizing pneumonia as well as sepsis and hemolytic uremic syndrome. Complicated CAP should always be suspected in cases of the deteriorating clinical status of the patient, prolonged and persistent fever, increased respiratory failure despite adequate treatment for 48 hours. Chest X–ray and ultrasound are one of the most common diagnostic tools of complicated pneumonia; however, about 20 per cent of cases have no visible changes. For this reason, chest CT is recommended. All children diagnosed with complicated CAP should be treated in tertiary hospitals with accessibility to the pediatric intensive care unit and the possibility for the comprehensive examination andmultidisciplinary care.