Complicações da pneumonia adquirida na comunidade em crianças: fatores associados e a associação com falha terapêutica

Abstract

OBJECTIVE: To analyze the prevalence of complications of community-acquired pneumonia (CAP) in children, to verify if there is an association of complications with therapeutic failure, and to analyze factors associated with them. METHODS: Cross-sectional, observational, retrospective review of medical records of children aged 0 to 17 years diagnosed with CAP, admitted to the general pediatric ward of the Pequeno Príncipe Hospital in Curitiba, from March 1, 2018 to March 1, 2019. Chronic lung diseases, neurological disorders, genetic diseases, heart disease, immunodeficiencies, hospital-acquired pneumonia, or incomplete data were excluded from the study. RESULTS: Of the 74 medical records chosen for the study, 54(73%) were children who did not develop complications and 20(27%) developed complications, in the following order of prevalence: pleural effusion 18(24.3%), empyema 7( 9.5%) and pulmonary necrosis 7(9.5%). Primary therapeutic failure, C-reactive protein (CRP) values, hemoglobin and rods collected at admission were associated with complications by Students t-test analysis with p-value <0.05. It was not possible to identify an association of bacterial resistance and therapeutic failure because there was no bacterial growth in the cultures. CONCLUSION: The prevalence of CAP complications was 27%. Pleural effusion was the most common complication, followed by empyema and pulmonary necrosis. Complicated pneumonia was associated with therapeutic failure in 70% of cases (p=0.03). As it was not possible to identify the causative pathogen by blood culture, it is concluded that admission exams such as PCR, hemoglobin and rods can help in the direction of the empirical choice of antibiotic.