BACKGROUND: Pneumonia remains a leading cause of pediatric morbidity globally, with Streptococcus pneumoniae (SP) as the primary bacterial pathogen. Despite vaccination programs and modern antibiotics, complicated cases requiring surgical intervention present ongoing challenges for healthcare providers. Recent clinical observations suggest an increase in complicated pneumonia cases requiring surgical intervention, particularly in the post-COVID-19 era. This trend warrants systematic investigation to optimize treatment protocols and surgical timing. OBJECTIVE: Primary objectives: Examine epidemiological trends in pediatric pneumonia (2019-2023) and evaluate surgical treatment outcomes. Secondary objectives: Analyze demographic and clinical characteristics, assess treatment response patterns and investigate factors associated with complicated disease courses. METHODS: A retrospective, single-center study was conducted at Thomayer University Hospital, Prague, Czech Republic, analysing medical records of children diagnosed with pneumonia in years 2019-2024. Data highly suggestive to Streptococcus pneumoniae were assessed for trends in incidence, clinical characteristics, treatment outcomes, surgical interventions, and antibiotic resistance. Statistical analysis using linear regression and Somers' D statistic confirmed an increasing trend in total and complicated pneumonia cases in the years following the onset of the pandemic. Three figures depict severe cases. RESULTS: We collected a total of 305 pediatric patients with community-acquired pneumonia (CAP). A total of 181 patients out of all CAP patients (59.3%) were suspected from pneumococcal aethiology. About 12.1% were identified as complicated. The statistical models showed significant increases over time (P < 0.05), with the complication rate rising by 0.143 per year (R² = 0.804) and interventions increasing by 0.062 per year (R² = 0.69). CONCLUSION: This study highlights a rising incidence of bacterial pneumonia, mainly pneumococcal, and its severe forms in children, particularly after the emergence of the pandemic. The findings underscore the need for a multidisciplinary approach and the role of minimally invasive surgical techniques in managing complex cases. .

Pneumonia is a common and serious lung infection in children. Pneumococcus is one of the main bacteria that causes it. Thanks to vaccines and antibiotics, many cases are mild and can be treated effectively. However, some children develop severe forms of pneumonia, which can lead to complications requiring surgery. Recent reports suggest that the number of complicated pneumonia cases has increased, especially after the COVID-19 pandemic. To understand this trend, we studied cases of pneumonia in children treated at Thomayer University Hospital in Prague between 2019 and 2024. We analyzed how often Pneumococcus was involved, how severe the cases were, and whether more children needed surgery over time. We found that out of 305 children with pneumonia, 181 (59.3%) were likely to have pneumococcal pneumonia. About 12% of these children developed severe complications. Our analysis showed a clear increase in the number of complicated cases and surgical interventions over time, especially after COVID-19. One particularly severe form, necrotizing pneumonia, which destroys lung tissue, was more common in recent years. These findings suggest that complicated bacterial pneumonia is becoming more frequent in children, and doctors may need to adjust their treatment strategies. Using less invasive surgical techniques and ensuring timely medical care could help improve outcomes for children with severe pneumonia.

Clinic of Paediatrics of the 1st Faculty of Medicine Charles University Thomayer University Hospital Prague Czech Republic

Clinic of Thoracic Surgery 3rd Faculty of Medicine Charles University and Thomayer University Hospital Prague Czech Republic

Department of Clinical Microbiology Thomayer University Hospital Prague Czech Republic

Department of Pediatric Intensive Care Thomayer University Hospital Prague Czech Republic

Department of Radiology Thomayer University Hospital Prague Czech Republic

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Olarte L, Jackson MA. Streptococcus pneumoniae. PubMed DOI

Ki Wook Y. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. PubMed DOI PMC

Dion CF, Ashurst JV. Streptococcus pneumoniae. In:

Herera-Lara S, Fernández-Fabrellas E, Cervera-Juan Á, Blanquer-Olivas R. Do seasonal changes and climate influence the etiology of community-acquired pneumonia? PubMed DOI

Cheliotis SK, Jewell P, Solórzano C, et al. Influence of sex, season, and environmental air quality on experimental human pneumococcal carriage acquisition. PubMed DOI PMC

Domenech de Cellès M, Arduin H, Lévy-Bruhl D, et al. Unraveling the seasonal epidemiology of pneumococcus. PubMed DOI PMC

Miller JM, Binnicker MJ, Campbell S, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the IDSA and ASM. PubMed DOI PMC

Morpeth SC, Deloria Knoll M, Scott JAG, et al. Detection of pneumococcal DNA in blood by polymerase chain reaction for diagnosing pneumococcal pneumonia in young children from low- and middle-income countries. PubMed DOI PMC

Domínguez J, Blanco S, Rodrigo C, et al. Usefulness of urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children. PubMed DOI PMC

Yavuz S, Sherif A, Amirrad M, et al. A retrospective chart review of pediatric complicated community-acquired pneumonia: an experience in the Al Qassimi women and children hospital. PubMed DOI PMC

de Benedictis FM, Kerem E, Chang AB, et al. Complicated pneumonia in children. PubMed DOI

Cao Y, Zhao L, Miao H. [Risk factors for progression to severe pneumonia in children visiting the emergency department with pneumonia]. PubMed DOI

Fernandez Elviro C, Longcroft-Harris B, Allin E, et al. InsightScope Team. Conservative and surgical modalities in the management of pediatric parapneumonic effusion and empyema: a living systematic review and network meta-analysis. PubMed DOI

Mohajerzadeh L, Lotfollahzadeh S, Vosoughi A, et al. Thoracotomy versus video-assisted thoracoscopy in pediatric empyema. PubMed DOI PMC

Iroh Tam PY, Bernstein E, Ma X, Ferrieri P. Blood culture in evaluation of pediatric community-acquired pneumonia: a systematic review and meta-analysis. PubMed DOI

Ricketson LJ, Lidder R, Thorington R, et al. PCR and culture analysis of Streptococcus pneumoniae nasopharyngeal carriage in healthy children. PubMed DOI PMC

Ceyhan M, Karadag-Oncel E, Hascelik G, et al. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged less than five years. PubMed DOI

Ito A, Ishida T, Tachibana H, et al. Time trend of the sensitivity of the pneumococcal urinary antigen test for diagnosing pneumococcal community-acquired pneumonia. PubMed DOI PMC

North East of England Paediatric Respiratory Infection Study Group; Elemraid MA, Rushton SP, Clark JE, et al. A case-control study to assess the urinary pneumococcal antigen test in childhood pneumonia. PubMed DOI

Hindls R, Hronová S, Seger J, Fischer J.

Hebák P.

Lai JY, Yang W, Ming YC. Surgical management of complicated necrotizing pneumonia in children. PubMed DOI

Le Roux DM. Childhood deaths due to pneumonia: a novel causal analysis of aetiology. PubMed DOI

de Freitas Freire T, Cordova de Souza E, de Ribamar J, et al. Treatment of complicated bacterial pneumonia in children. DOI

Marquart ME. Pathogenicity and virulence of Streptococcus pneumoniae: cutting to the chase on proteases. PubMed DOI PMC

Kozáková J, Žemličková H, Vohrnová S, Křížová P. Invasive pneumococcal disease in the Czech Republic in 2022.

Izquierdo C, Ciruela P, Soldevila N, et al. Changes in invasive pneumococcal disease in the paediatric population in the second COVID-19 pandemic year. PubMed DOI PMC

Bertran M, Amin-Chowdhury Z, Sheppard CL, et al. Increased incidence of invasive pneumococcal disease among children after COVID-19 pandemic, England. PubMed DOI PMC

Kizil MC, Kara Y, Bozan G, et al. Consecutive seven serious cases with invasive group A streptococcal infections at December 2022–January 2023. PubMed DOI

ISIS-AR Study Group; GAS Study Group; de Gier B, Marchal N, de Beer-Schuurman I, et al. Increase in invasive group A streptococcal (Streptococcus pyogenes) infections (iGAS) in young children in the Netherlands, 2022. PubMed DOI PMC

Valcarcel Salamanca B, Cyr PR, Bentdal YE, et al. Increase in invasive group A streptococcal infections (iGAS) in children and older adults, Norway, 2022 to 2024. PubMed DOI PMC

Goretzki SC, van der Linden M, Itzek A, et al. Outbreak of severe community-acquired bacterial infections among children in North Rhine-Westphalia (Germany), October to December 2022. PubMed DOI PMC

Taha S, Deghmane AE, Taha MK. Recent increase in atypical presentations of invasive meningococcal disease in France. PubMed DOI PMC

Rybak A, Yang DD, Schrimpf C, et al. Fall of community-acquired pneumonia in children following COVID-19 non-pharmaceutical interventions: a time series analysis. PubMed DOI PMC

Shaw D, Abad R, Amin-Chowdhury Z, et al. Trends in invasive bacterial diseases during the first 2 years of the COVID-19 pandemic: analyses of prospective surveillance data from 30 countries and territories in the IRIS Consortium. PubMed DOI PMC

Cohen R, Levy C, Rybak A, et al. Immune debt: recrudescence of disease and confirmation of a contested concept. PubMed DOI PMC

Weinberger DM, Malley R, Lipsitch M. Serotype replacement in disease after pneumococcal vaccination. PubMed DOI PMC

Cella E, Sutcliffe CG, Grant LR, et al. PubMed DOI PMC

Ekinci E, Van Heirstraeten L, Willen L, et al. Serotype 19A and 6C account for one-third of pneumococcal carriage among Belgian day-care children four years after a shift to a lower-valent PCV. PubMed DOI PMC

Hughes GJ, Wright LB, Chapman KE, et al. Serotype-specific differences in short- and longer-term mortality following invasive pneumococcal disease. PubMed DOI PMC

Kozakova J.

Kopriva F, Latalova V. Different approaches to pneumonia in children depending on the age and aetiology. DOI

Brook I. The role of beta-lactamase-producing bacteria in mixed infections. PubMed DOI PMC

Beraud G. Shortages without frontiers: antimicrobial drug and vaccine shortages impact far beyond the individual! PubMed DOI PMC

Shafiq N, Pandey AK, Malhotra S, et al. Shortage of essential antimicrobials: a major challenge to global health security. PubMed DOI PMC

Frybova B, Koucky V, Pohunek P, et al. Lung resection in children with necrotizing pneumonia: outcome and follow-up. PubMed DOI

Kern L, Robert J, Brutsche M. Management of parapneumonic effusion and empyema: medical thoracoscopy and surgical approach. PubMed DOI

Subramaniam R, Joseph VT, Tan GM, et al. Experience with video-assisted thoracoscopic surgery in the management of complicated pneumonia in children. PubMed DOI

Chibuk TK, Cohen E, Robinson JL, et al. Paediatric complicated pneumonia: diagnosis and management of empyema. PubMed PMC