Management of Pediatric Community-Acquired Pneumonia in the Era of Widespread Vaccination against Streptococcus Pneumoniae at a First-Level Hospital

Abstract

Community-acquired pneumonia (CAP) is a common and potentially severe infection affecting children. A retrospective study was carried out at our Institution between November 2022 and January 2023. Twenty-eight patients under 14 years of age were diagnosed and treated accordingly. Median age was 35 months, half of the patients were males. The most detected pathogen was S. pneumoniae (in 36% of all patients). Other pathogens detected were RSV in 3 patients (11%), influenza B virus in two patients (7%), adenovirus in two patients (7%), and M. pneumoniae in one patient (4%). Fourteen children (50% of the total number) developed a respiratory failure that required supplemental oxygen. Among these, 8 children (57% of all children receiving oxygen supplementation) required low-flow oxygen delivery, four children (29%) required high-flow oxygen delivery, and one child (7%) required invasive ventilation. Five children (55% of children with a bacterial CAP) received intravenous antibiotics, while 44% of patients received oral antibiotics. First-line intravenous antibiotics consisted of a third-generation cephalosporin for infants and children older than 1 month, and ampicillin/sulbactam with gentamicin for newborns. Amoxy-clavulanic acid was the first-line oral antibiotic for pneumococcal CAP, while oral clarithromycin was the first line antimicrobic for CAP caused by M. pneumoniae. Twenty-one children (75% of total patients) were fully vaccinated, three children (11%) had received two doses because of age. Regarding the 10 children with a pneumococcal CAP, seven (70%) were fully vaccinated, one had received two-doses of pneumococcal conjugate vaccine (PCV), and two were unvaccinated.