Abstracts DGKCH

Background:Necrotizing pneumonia (NP) is a rare, but serious complication of pneumonia, with a rising incidence.NP can lead to prolonged disease and increased mortality, particularly in children.NP is characterized by the destruction of lung tissue and the frequent need for surgical intervention (SI) after unsuccessful conservative treatment.NP is associated with a higher risk of complications, including empyema, pyopneumothorax, bronchopleural fistula (BPF) and sepsis.An early prediction and targeted management are crucial for rapid reconvalescence.Currently, there are no evidence-based recommendations for the diagnosis, treatment and optimal timing of SI for patients with NP.This study aims to identify the potential predictors of complicated pneumonia (CP) in patients who have undergone SI for NP. Materials and methods:The analysis includes clinical data from all patients conservatively and surgically managed on an interdisciplinary basis for CP and NP between 2017 and 2024.Demographic data (age, sex, diagnosis, antibiotic therapy, pathogen detection, length of hospital stay, surgical procedure, time to surgery postadmission, complications, maximum oxygen demand, type of respiratory support, vital signs inflammation values, fever, comorbidities, allergies, chronic medications, vaccinations, and postoperative management) were retrospectively analyzed, including the results of imaging procedures. Results:Twelve patients (m/f = 5/7) underwent SI for CP following unsuccessful conservative treatment.The median age was 4 3.2 years.The average hospital stay for the patients with NP was 38 10.3 days.The first SI occurred on average 6 1.27 days post-admission.All patients initially underwent videoassisted thoracoscopic surgery with pleurolysis and chest tube insertion.Three patients previously received chest tubes.Two patients required partial lung resection, one during the primary surgery and the other on the 13th postoperative day.BPF were present in 3/5 NP patients, 2 managed by intervention with occluders.80% of the NP patients had recurrent fever under antibiotic therapy and increased oxygen demand the day before surgery, whereas all patients with CP remained stable under conservative treatment.The inflammatory parameters could not be identified as indicators for SI.Three patients with NP received high-flow nasal cannula oxygen and one was intubated for bilevel positive airway pressure.All NP patients presented with tachypnea, tachycardia, and ultrasound-confirmed lung consolidation, with 3/4 showing septated pleural effusions.Preoperative CT confirmed NP in 3 patients.None of the patients had relevant comorbidities, allergies, immunodeficiencies or medications.Streptococcus pneumoniae was isolated in all NP cases, with one patient also testing positive for Respiratory-Syncytial-Virus and another for Moraxella catarrhalis.All patients received at least two doses of pneumococcal conjugate vaccines.Patients were treated with antibiotics for an average of 44 5.2 days, which were completed either at discharge or during follow-up.Follow-up checks were carried out between weeks 1-4 after discharge, after 4 months and 6 months -1 year.80% of the patients made a full recovery with no pathologies in the chest X-ray and had a normal lung function.The follow-up of one patient has not yet been completed. Conclusion:The NP treatment in children is challenging and requires interdisciplinary collaboration.Important indicators for early transitioning to SI under escalated antibiotic therapy can be fever, increasing oxygen demand, tachycardia, tachypnea, and radiological evidence of septate effusions, cavitations, and BPF.Early diagnosis by chest ultrasound and CT is crucial for initiating SI.Partial lung resection and fistula closure are often unavoidable in case of unsuccessful conservative treatment.Careful preoperative management and comprehensive postoperative care, including pathogen identification, a long-term antibiotic therapy, and close follow-up, could minimize the risk of late complications.Further research with larger studies is needed to determine the best treatment strategies for children with CP and NP.