Increased incidence of bronchopulmonary fistulas complicating paediatric pneumonia.

Andrea Mckee (1) , Ian Balfour-Lynn (2) , Andrew Ives (2)

1 Paediatric Respiratory Medicine
2 Paediatric Respiratory Medicine

Background. The frequency of complicated pneumococcal disease, including necrotising pneumonia, has increased over the last decade. During 2008-9, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. Methods. This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002-7, compared with 2008-9. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. Results. During the 8 year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (p<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs 10 days, p<0.0001) and surgical intervention rate (2 vs 14%, p=0.001). In the latter 2 years, S.pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without. Conclusions. The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-9. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.

Mots clés: Medicine

Andrea Mckee, Ian Balfour-Lynn, Andrew Ives. Increased incidence of bronchopulmonary fistulas complicating paediatric pneumonia.. Pediatric Pulmonology, 2011, 46 (7), pp.717. ⟨10.1002/ppul.21396⟩. ⟨hal-00645193⟩