Severe pneumonia in children: Causes, diagnosis, and treatment

Vaccines have substantially reduced the incidence of pediatric pneumonias caused by Haemophilus influenzae type b and certain serotypes of Streptococcus pneumoniae. However, other organisms are being identified more frequently, including methicillin-resistant Staphylococcus aureus (MRSA) and serotypes of S pneumoniae that are not covered by the pneumococcal vaccine. Although chest radiographs are still a basic component of the assessment of pneumonia, CT scans are increasingly being used to differentiate effusion from empyema and consolidation and to evaluate for pleural fluid loculations, lung abscesses, and lung necrosis. β-Lactams, particularly extended-spectrum cephalosporins, remain an important cornerstone of the treatment of complicated pneumonia. In areas where community-acquired MRSA is a concern, empirical coverage for this pathogen should be considered in patients with a severe or necrotizing pneumonia.