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Significant increase in lung resections for necrotizing pneumonia in children in the past decade: outcomes and follow-up
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  • Barbora Frybova,
  • Vaclav Koucky,
  • Petr Pohunek,
  • Kristyna Cejnarova,
  • Stepan Coufal,
  • Alena Kokesova,
  • Vojtech Dotlacil,
  • Natalia Petrasova,
  • Lucie Pos,
  • Jiri Snajdauf,
  • Michal Rygl
Barbora Frybova
Motol University Hospital
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Vaclav Koucky
Motol University Hospital Department of Pediatrics
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Petr Pohunek
Motol University Hospital
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Kristyna Cejnarova
Motol University Hospital
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Stepan Coufal
Institute of Microbiology Czech Academy of Sciences
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Alena Kokesova
Motol University Hospital
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Vojtech Dotlacil
Motol University Hospital
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Natalia Petrasova
Motol University Hospital
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Lucie Pos
Motol University Hospital
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Jiri Snajdauf
Motol University Hospital
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Michal Rygl
Motol University Hospital
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Abstract

Aim of the study: To review the occurrence, follow-up, and outcome of necrotizing pneumonia requiring surgical management. Methods: A prospective–retrospective, single-centre study of patients with necrotizing pneumonia managed between 1 January 2010 and 31 December 2019. Main results: The study cohort consisted of 1,295 patients admitted to the paediatric department for pneumonia, 36 of whom underwent parenchymal lung resection. A five-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last three years (P<0.05). The median age at the time of surgery was 32.5 (interquartile range: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, pre-resection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%) and pneumonectomy (5.6%). The post-operative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry performed 39.3 months (median) after surgical intervention was normal in 68.3% of patients, restriction was detected in 10.0%, and peripheral obstruction in 18.3%. Conclusions: Despite high rates of vaccination against pneumococcus, the number of patients with necrotising pneumonia requiring resection has increased significantly in the last three years (P<0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favourable lung function outcome.

Peer review status:UNDER REVIEW

10 Jun 2020Submitted to Pediatric Pulmonology
11 Jun 2020Assigned to Editor
11 Jun 2020Submission Checks Completed
13 Jun 2020Review(s) Completed, Editorial Evaluation Pending