Abstract：
BACKGROUND: Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated.
METHODS: We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study.
RESULTS: The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae.
CONCLUSIONS: Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.
METHODS: We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study.
RESULTS: The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae.
CONCLUSIONS: Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.
摘要：
背景：坏死性肺炎（NP）是儿童的一种严重且罕见的疾病。关于NP的儿科数据有限，对13价肺炎球菌结合疫苗的影响评价非常差。
方法：我们于2008年至2018年在图卢兹大学医院进行了一项回顾性研究。这项研究包括在影像学上在实质巩固区域出现薄壁腔的儿童。
结果：在此期间NP的发生率没有降低。56％的病例（14/25）发生细菌鉴定，其中包括6例肺炎链球菌，五种金黄色葡萄球菌，两种化脓性链球菌，和一种草绿色链球菌。与金黄色葡萄球菌NP相比,肺炎链球菌NP更频繁地与脓胸/肺炎旁积液相关(p=0.02)。与肺炎链球菌病例相比，化脓性链球菌NP患者更经常需要体积扩张（p=0.03）。当比较实施13价肺炎球菌结合疫苗前后出生的儿童时，我们确定了细菌流行病学的相对修改，化脓性链球菌NP和金黄色葡萄球菌NP的比例增加，肺炎链球菌引起的NP比例降低。
结论：需要未来的研究来评估儿童NP的流行病学。持续监测已确定的肺炎球菌血清型对于记录未来几年的流行病学变化至关重要。
方法：我们于2008年至2018年在图卢兹大学医院进行了一项回顾性研究。这项研究包括在影像学上在实质巩固区域出现薄壁腔的儿童。
结果：在此期间NP的发生率没有降低。56％的病例（14/25）发生细菌鉴定，其中包括6例肺炎链球菌，五种金黄色葡萄球菌，两种化脓性链球菌，和一种草绿色链球菌。与金黄色葡萄球菌NP相比,肺炎链球菌NP更频繁地与脓胸/肺炎旁积液相关(p=0.02)。与肺炎链球菌病例相比，化脓性链球菌NP患者更经常需要体积扩张（p=0.03）。当比较实施13价肺炎球菌结合疫苗前后出生的儿童时，我们确定了细菌流行病学的相对修改，化脓性链球菌NP和金黄色葡萄球菌NP的比例增加，肺炎链球菌引起的NP比例降低。
结论：需要未来的研究来评估儿童NP的流行病学。持续监测已确定的肺炎球菌血清型对于记录未来几年的流行病学变化至关重要。
