Incidence and Etiologies of Complicated Parapneumonic Effusions in Children, 1996 to 2001

Pediatr Infect Dis J. 2003 Jun;22(6):499-504. doi: 10.1097/01.inf.0000069764.41163.8f.

Abstract

Background: The incidence and causative organisms associated with complicated parapneumonic effusions in children with community-acquired pneumonia are likely to have changed during the past several years.

Methods: Data regarding clinical and laboratory features were abstracted retrospectively from medical records of 76 subjects with complicated parapneumonic effusions at a tertiary children's hospital from 1996 through 2001. Incidence rates per 10 000 hospital discharges and per 1000 patients with nonviral pneumonia were calculated.

Results: Etiologic organisms were Streptococcus pneumoniae (31 subjects), Staphylococcus aureus (7), Streptococcus pyogenes (5), Abiotrophia sp. (1) and no culture-confirmed agent (32). The annual incidence of complicated parapneumonic effusions per 10 000 discharges progressively increased from 4.5 in 1996 to 25.0 in 1999 (P = 0.0001), then declined to 10.1 in 2001 (P = 0.03). Similarly the incidence per 1000 cases of nonviral pneumonia increased from 2.9 in 1996 to 11.0 in 1999 (P = 0.003) and then declined to 4.8 in 2001 (P = 0.053). Whereas S. pneumoniae was the leading confirmed etiology in each year, the proportion of cases caused by Staphylococcus aureus increased from 6% in 1996 to 2000 (all of which were methicillin-susceptible) to 30% in 2001 (all methicillin-resistant; P = 0.04).

Conclusions: The incidence of complicated parapneumonic effusions in children with community-acquired pneumonia increased from 1996 to 1999 and then declined concomitant with the introduction of the pneumococcal conjugate vaccine. Although cases caused by S. pneumoniae have decreased, community onset methicillin-resistant Staphylococcus aureus has emerged as a cause of pneumonia with complicated effusions in children.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Anti-Bacterial Agents / pharmacology
  • Child
  • Child, Preschool
  • Community-Acquired Infections / epidemiology*
  • Community-Acquired Infections / microbiology
  • Female
  • Hospitalization / statistics & numerical data
  • Hospitals, Pediatric
  • Humans
  • Incidence
  • Infant
  • Male
  • Microbial Sensitivity Tests
  • Pleural Effusion / epidemiology*
  • Pleural Effusion / microbiology*
  • Pneumonia, Bacterial / epidemiology*
  • Pneumonia, Bacterial / microbiology
  • Probability
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sex Distribution
  • Staphylococcus aureus / isolation & purification
  • Statistics, Nonparametric
  • Streptococcus pneumoniae / isolation & purification
  • Streptococcus pyogenes / isolation & purification

Substances

  • Anti-Bacterial Agents