Clinical Course and Outcomes of Complicated Community-Acquired Pneumonia in Children During a 5-Year Period Including the COVID-19 Pandemic

Abstract

Objective: Community-acquired pneumonia (CAP) remains a significant cause of morbidity in children. Despite widespread vaccination, the incidence and clinical course of complicated CAP (cCAP) continue to pose diagnostic and therapeutic challenges. This study aimed to evaluate the clinical course, management, and outcomes of children with cCAP in pediatric clinical practice. Methods: This retrospective–prospective observational study was conducted at a tertiary university hospital between December 2019 and December 2024. Children under 18 years of age diagnosed with cCAP were included. Results: A total of 52 children were included, with a median age of 70.5 months; 48.1% were female. Parapneumonic effusion (PPE) was the most common complication (86.5%), followed by empyema (21.2%) and necrotizing pneumonia (7.6%). Bacterial pathogens were identified in a minority of cases. Among the limited number of culture-positive cases, group A Streptococcus and Streptococcus pneumoniae were the most frequently identified organisms (11.5%, n = 6). Chest tube thoracostomy was required in 60% of patients, and surgical intervention in 9.6%. Patients requiring chest tube placement had significantly higher C-reactive protein (CRP) levels and longer durations of intravenous (IV) antibiotic therapy. No mortality was observed. Conclusions: Despite extensive vaccination in healthy children, cases of cCAP still occur, and the causative agent is isolated only in a very few cases. The findings are consistent with the fact that vaccine breakthrough infections, including those caused by pneumococcal serotypes 3 and 14, may still contribute to severe cCAP, whereas group A Streptococcus was identified in a minority of culture-positive cases. Elevated CRP levels at admission may serve as a useful predictor for invasive interventions.