Introduction: The use of betalactamics plus macrolides as the empiric treatment in community acquired pneumonia (CAN) is very common. However, several studies advise against this practice. The objective of this study is to compare the effectiveness of betalactamic monotherapy against a macrolide combination therapy for children hospitalized with pneumoniae.
Material and Method: A unicentre retrospective population-based study of CAN hospitalizations (CIE-9 486) conducted from January 1st 2013 to December 31st 2017. The sample was divided in two cohorts. One who received betalactam monotherapy (ampiciline, amoxicilline, clavulanate- amoxicilline or cephalosporines), and the other who received β-lactam plus macrolide (erithromicine, clarythromicine or azythromicine) combination therapy. The main outcome was the length of stay.
Results: Our study included 156 children hospitalized with pneumoniae. 11 did not received antibiotics because of viral etiology, 12 received 3 or more antibiotics, thus the final sample was of 56 patients with monotherapy and 43 with macrolide combined therapy. The characteristics in terms of age, gender, and antipneumococcical vaccination were similar within them. The length of stay and the use of non invasive ventilation in the monotherapy cohort were lower than in the macrolide combined therapy cohort but this difference was not significant. More pleural effusions were observed in the macrolide combined therapy group (21 vs 5%) (p= 0.016).
Conclusions: Empirical macrolide combination therapy conferred no benefit in the length of stay over β-lactam monotherapy for children hospitalized with community-acquired pneumonia.

L. González-Martín. Unidad de Urgencias de Pediatría. Hospital Universitario Río Hortega. C/Dulzaina, 2. 47012 Valladolid. Correo electrónico: lgonzalezmartin@gmail.com

We report the case of a 12 month old boy who suffered recurrent episodes of fever, cough and respiratory distress and evidence of a persistent image of alveolar consolidation in the right upper lobe on chest radiography. We discuss the differential diagnosis list and the management of the case. Finally, we detect in our patient the presence of a tracheal bronchus.
Thracheal bronchus is considered an anatomical variant, usually asymptomatic, but can show up with recurrent infections as occurred in our patient. It may also be associated with other congenital malformations. The conservative treatment is the best choice and consists in chest physiotherapy and the treatment of inflammation and infection. The need for surgery is uncommon.
Most of the congenital bronchial abnormalities may go unnoticed because they are normally asymptomatic. However, in chronic or recurrent respiratory processes they must be ruled out.
The early detection of these malformations can prevent the appearance of chronic lung diseases and can allow for the best therapeutic approach. Although most of the cases do not require treatment, some of them require specific and more aggressive handling.

Background: Recurrent pneumonia (RP) is defined as the presence of radiographic infiltrates recurring after complete resolution of initial pneumonic process. Although it is a common cause of demand for assistance in pediatric respiratory units, there are few studies to evaluate the actual impact.
Patients and methods: A descriptive study of patients diagnosed with RP in the Pediatric Respiratory Unit of Carlos Haya's University Hospital (Málaga), both ambulatory and in hospital wards during a period of one year. We proceeded to the devel­opment of a database through an evaluation questionnaire.
Results: We collected 157 patients with RP, 61.8% attended in outpatient clinics and 37.6% in hospital wards. Etiological diagnosis was established in 97.5% of cases, the most frequent asthma (37.2%), cystic fibrosis (23.7%) and aspiration syndrome (11.5%). In 75.3% of recurrences location was variable, 14.3% were unique location and 9.7% had interstitial distribution.
Conclusions: The clinical history and detailed physical examination, with radiographic features, guide the diagnosis of RP in most cases. Choose of additional tests depends on the location of recurrences, the patient's age and the prevalence of the diseases. In our study, overall, the most common underlying causes of RP were asthma, cystic fibrosis and chronic aspiration syndromes.

Acute lower respiratory tract infections (LRTIs) are the most common infections in children; approximately 1.5% of those infections are pneumonias. It is difficult to establish the incidence of pneumonia since it is a benign process with no official reporting obligation, but it is estimated that there are 15 to 40 cases per thousand children and year according to age.

Pneumonias are the main cause of respiratory morbidity worldwide and the third cause of death in developed countries; commonly, resolution is the norm. However, in some cases the clinical and radiological evolution is not favourable in spite of a supposedly appropriate treatment. In those cases, a systematic diagnosis is required in order to clarify the causes of the abnormal evolution and establish a correct treatment.

The community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a bacterium that is frequently involved in severe infections and various locations. In this article we describe the actual state of CA-MRSA infections in pediatrics, and we illustrate it with two examples of virulent infection in healthy pediatric patients. The first case is in a patient with septic arthritis and necrotizing pneumonia caused by CA-MRSA, and the second one is in an unweaned baby with pleuropneumonia caused by CA-MRSA. Both cases are a clear example of the importance of this emerging infection in pediatrics.

Objective: To describe our experience in the diagnosis and treatment of children with community-acquired pneumonia (CAP) that need hospitalization, and to analyze the factors that influence the development of parapneumonic pleural effusion (PPE).

Material and methods: Observational study of a prospective cohort. Consecutive sample of children aged 2 to 14 years admitted with CAP between July 2007 and February 2008. Independent variables: age, sex, days of stay, previous pathology, previous antibiotic therapy, vaccination with heptavalent pneumococcal conjugated vaccine (PCV7), symptomatology, white blood cells and neutrophils, C reactive protein, pneumococcal antigen in urine, blood culture, serology of Mycoplasma, tuberculin test, chest radiology, antibiotic therapy. Primary outcomes: pleural effusion development and its treatment. We fit a multivariable logistic regression (LR) model.

Results: 102 patients. Median age 4.8 years, 13% had a history of bronchospasm. In 26 vaccinations with PCV7 was complete, incomplete in 29, and 46 cases had not been vaccinated. 23 patients developed PPE, 10 needed pleural drainage and urokinase, 1 exclusively drainage, the rest of the patients conservative treatment. We report an incidence of PPE 95% (CI= 13.95-31.15). After the statistical analysis (LR) we see that both PCV7 complete vaccination (p= 0.01) and serology evidence of acute Mycoplasma infection (p= 0.01) independently predict the development of PPE.

Conclusion: Treatment with drainage with or without effective fibrinolysis in all cases. Our data allows us to guess estimate a possible causal role of PCV7 and Mycoplasma pneumoniae coinfection in PPE development.