title: Risk factors of progressive community-acquired pneumonia in hospitalized children: a prospective study.
abstract: BACKGROUND
  Complications regarding pneumonia occur in children during hospitalization and treatment. The objective of this study is to identify the risk factors of progressive pneumonia in order to institute early appropriate therapy.
  
  
  METHODS
  This was a prospective study which involved the pediatric departments of seven medical centers in Taiwan. Children aged from 6 weeks to 18 years old, hospitalized with community-acquired pneumonia (CAP) from January 2010 to August 2011, were enrolled. Progressive pneumonia was defined by the deterioration of discharge diagnosis as compared to admission. Demographic, clinical, and laboratory variables, diagnosis, antimicrobial therapy, and pathogens were compared.
  
  
  RESULTS
  Four hundred and two children were included and 57 (14.2%) had progressive pneumonia. Independent associated factors identified for the development of progressive disease, by multivariate logistic regression analysis, included the following, age < 2 years, pleural effusion as admission diagnosis, Hb < 10 g/dL, WBC count > 17,500/μL, tachypnea, and duration to defervescence > 3 days. Streptococcus pneumoniae was the main etiology for progressive pneumonia (57.9%). There was no difference in choice of initial parenteral antibiotics between groups of progressive and non-progressive pneumococcal pneumonia.
  
  
  CONCLUSIONS
  We found six clinical factors for predicting progressive pneumonia. Further evaluation should be performed in hospitalized pneumonic children with persistent fever not responding to therapy within 72 hours. The initial parenteral antibiotics were not related to the progression of pneumococcal pneumonia.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ching-Ying
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Lung
authors.initials: L
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Luan-Yin
authors.initials: LY
authors.lastname: Chang
authors.affiliation: Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Yi-Chuan
authors.initials: YC
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.affiliation: Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsiao-Chuan
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
authors.forename: Yu-Huai
authors.initials: YH
authors.lastname: Ho
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan. Electronic address: chi.4531@ms1.mmh.org.tw.
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: lmhuang@ntu.edu.tw.
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Children; Community-acquired pneumonia; Progressive pneumonia; Risk factor