Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia

Pediatr Pulmonol. 2011 Jul;46(7):717-21. doi: 10.1002/ppul.21396. Epub 2011 May 27.


Background: The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause.

Methods: This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without.

Results: During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P<0.0001) and surgical intervention rate (2% vs. 14%, P=0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without.

Conclusions: The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Bronchial Fistula / drug therapy
  • Bronchial Fistula / epidemiology*
  • Bronchial Fistula / microbiology
  • Child
  • Child, Preschool
  • Empyema, Pleural / drug therapy
  • Empyema, Pleural / epidemiology*
  • Empyema, Pleural / microbiology
  • England / epidemiology
  • Female
  • Humans
  • Incidence
  • Infant
  • Length of Stay
  • Male
  • Pneumococcal Vaccines / therapeutic use
  • Pneumonia, Pneumococcal / drug therapy
  • Pneumonia, Pneumococcal / epidemiology*
  • Pneumonia, Pneumococcal / microbiology
  • Retrospective Studies
  • Streptococcus pneumoniae / isolation & purification


  • Anti-Bacterial Agents
  • Pneumococcal Vaccines