Risk factors of progressive community-acquired pneumonia in hospitalized children: A prospective study

Background: Complications regarding pneumonia occur in children during hospitalization and treatment. The objective of this study is to identify the risk factors of progressive pneumonia in order to institute early appropriate therapy. Methods: This was a prospective study which involved the pediatric departments of seven medical centers in Taiwan. Children aged from 6 weeks to 18 years old, hospitalized with community-acquired pneumonia (CAP) from January 2010 to August 2011, were enrolled. Progressive pneumonia was defined by the deterioration of discharge diagnosis as compared to admission. Demographic, clinical, and laboratory variables, diagnosis, antimicrobial therapy, and pathogens were compared. Results: Four hundred and two children were included and 57 (14.2%) had progressive pneumonia. Independent associated factors identified for the development of progressive disease, by multivariate logistic regression analysis, included the following, age<2 years, pleural effusion as admission diagnosis, Hb<10g/dL, WBC count > 17,500/μL, tachypnea, and duration to defervescence > 3 days. Streptococcus pneumoniae was the main etiology for progressive pneumonia (57.9%). There was no difference in choice of initial parenteral antibiotics between groups of progressive and non-progressive pneumococcal pneumonia. Conclusion: We found six clinical factors for predicting progressive pneumonia. Further evaluation should be performed in hospitalized pneumonic children with persistent fever not responding to therapy within 72 hours. The initial parenteral antibiotics were not related to the progression of pneumococcal pneumonia.