Presenter Status
Resident/Psychology Intern
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Marina Dantas, MD, MSCR
Presentation Type
Poster
Start Date
20-5-2026 11:00 AM
End Date
20-5-2026 12:00 PM
Abstract Text
Background: Community‑acquired pneumonia (CAP) remains the leading cause of morbidity and mortality in children aged 28 days to 5 years worldwide. A subset of patients develop complicated community-acquired pneumonia (cCAP)- defined as CAP with parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess. These infections are associated with more severe illness, prolonged hospitalization, increased ICU utilization, invasive procedures, and broader antimicrobial exposure. Streptococcus pneumoniae, group A Streptococcus, and Staphylococcus aureus (both methicillin sensitive and methicillin resistant strains) are traditionally considered the most common bacterial pathogens in CAP. However, there is not comprehensive data on their prevalence in cCAP, as most sources combine cCAPwith CAP. This likely contributes to variability in antibiotic selection (both empiric and definitive) for cCAP. Clarifying pathogen prevalence in cCAP would ensure better pathogen-antibiotic concordance and improve antibiotic stewardship.
Objectives/Goal: To identify the bacterial pathogens most frequently isolated in children hospitalized with cCAP and to evaluate whether empiric and definitive antibiotic selection align with pathogen prevalence, with emphasis on methicillin-resistant Staphylococcus aureus(MRSA)-directed antibiotics.
Methods/Design: We performed a single center chart review of children aged 60 days to 18 years hospitalized with cCAP at Children’s Mercy Kansas City. Using billing codes, we identified medical records for children with bacterial pneumonia with moderate to large effusion/empyema requiring drainage procedure, abscess, cavitation, necrotizing pneumonia, pneumothorax, or bronchopleural fistula. Each record was then screened for eligibility, and patients were excluded based on any of the following: chronic lung disease, structural cardiac condition, immunodeficiency, chronic immunosuppression, malignancy/neoplasm, transplanted patient, nonphysiological airway at baseline. Data extracted included imaging findings, drainage procedures, microbiologic testing, and empiric and definitive antibiotic selection and duration. MRSA-directed antimicrobials within our data set included vancomycin, clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and linezolid. All information was captured and standardized within REDCap. Descriptive statistics were utilized to describe the cohort. This study is ongoing, and the results below are preliminary.
Results: Of 129 charts reviewed, 19 (92%) had pleural effusion/empyema, 117 (91%) underwent pleural/abscess fluid drainage, and 25 (19%) required ICU admission during their hospitalization. Most had blood (76%) or fluid (90%) cultures obtained. Following microbial testing, 59 (46%) had no identified pathogen, 40 (31%) were positive for Streptococcus pneumoniae, 8 (6%) were positive for Streptococcus pyogenes, 7 (5%) were positive for methicillin‑resistant Staphylococcus aureus (MRSA), and 3 (2%) were positive for methicillin‑sensitive Staphylococcus aureus (MSSA). Empiric MRSA‑directed therapy was initiated in 90% of patients. After definitive microbiologic results were available, MRSA coverage was continued in 49% of cases. Notably, 59% of patients without an identified pathogen remained on MRSA‑directed therapy for the duration of treatment.
Conclusions: Despite a low prevalence of MRSA in this cohort, the majority of patients received empiric MRSA coverage, and nearly halfcontinued MRSA‑directed therapy even after pathogen identification. Children with no identified bacterial cause were also frequentlymaintained on MRSA‑directed antibiotics. These findings suggest substantial overtreatment with MRSA‑directed antimicrobials within the CMH population and highlight an opportunity for improved antimicrobial stewardship.
Antibiotic-Pathogen Concordance in Pediatric Complicated Community-Acquired Pneumonia
Background: Community‑acquired pneumonia (CAP) remains the leading cause of morbidity and mortality in children aged 28 days to 5 years worldwide. A subset of patients develop complicated community-acquired pneumonia (cCAP)- defined as CAP with parapneumonic effusion, empyema, necrotizing pneumonia, or lung abscess. These infections are associated with more severe illness, prolonged hospitalization, increased ICU utilization, invasive procedures, and broader antimicrobial exposure. Streptococcus pneumoniae, group A Streptococcus, and Staphylococcus aureus (both methicillin sensitive and methicillin resistant strains) are traditionally considered the most common bacterial pathogens in CAP. However, there is not comprehensive data on their prevalence in cCAP, as most sources combine cCAPwith CAP. This likely contributes to variability in antibiotic selection (both empiric and definitive) for cCAP. Clarifying pathogen prevalence in cCAP would ensure better pathogen-antibiotic concordance and improve antibiotic stewardship.
Objectives/Goal: To identify the bacterial pathogens most frequently isolated in children hospitalized with cCAP and to evaluate whether empiric and definitive antibiotic selection align with pathogen prevalence, with emphasis on methicillin-resistant Staphylococcus aureus(MRSA)-directed antibiotics.
Methods/Design: We performed a single center chart review of children aged 60 days to 18 years hospitalized with cCAP at Children’s Mercy Kansas City. Using billing codes, we identified medical records for children with bacterial pneumonia with moderate to large effusion/empyema requiring drainage procedure, abscess, cavitation, necrotizing pneumonia, pneumothorax, or bronchopleural fistula. Each record was then screened for eligibility, and patients were excluded based on any of the following: chronic lung disease, structural cardiac condition, immunodeficiency, chronic immunosuppression, malignancy/neoplasm, transplanted patient, nonphysiological airway at baseline. Data extracted included imaging findings, drainage procedures, microbiologic testing, and empiric and definitive antibiotic selection and duration. MRSA-directed antimicrobials within our data set included vancomycin, clindamycin, trimethoprim-sulfamethoxazole, doxycycline, and linezolid. All information was captured and standardized within REDCap. Descriptive statistics were utilized to describe the cohort. This study is ongoing, and the results below are preliminary.
Results: Of 129 charts reviewed, 19 (92%) had pleural effusion/empyema, 117 (91%) underwent pleural/abscess fluid drainage, and 25 (19%) required ICU admission during their hospitalization. Most had blood (76%) or fluid (90%) cultures obtained. Following microbial testing, 59 (46%) had no identified pathogen, 40 (31%) were positive for Streptococcus pneumoniae, 8 (6%) were positive for Streptococcus pyogenes, 7 (5%) were positive for methicillin‑resistant Staphylococcus aureus (MRSA), and 3 (2%) were positive for methicillin‑sensitive Staphylococcus aureus (MSSA). Empiric MRSA‑directed therapy was initiated in 90% of patients. After definitive microbiologic results were available, MRSA coverage was continued in 49% of cases. Notably, 59% of patients without an identified pathogen remained on MRSA‑directed therapy for the duration of treatment.
Conclusions: Despite a low prevalence of MRSA in this cohort, the majority of patients received empiric MRSA coverage, and nearly halfcontinued MRSA‑directed therapy even after pathogen identification. Children with no identified bacterial cause were also frequentlymaintained on MRSA‑directed antibiotics. These findings suggest substantial overtreatment with MRSA‑directed antimicrobials within the CMH population and highlight an opportunity for improved antimicrobial stewardship.
Comments
Poster Board Number: 21