Evan J. Anderson, MD

Vaccines have substantially reduced the incidence ofpediatric pneumonias caused by Haemophilus influenzae type band certain serotypes of Streptococcus pneumoniae. However,other organisms are being identified more frequently, includingmethicillin-resistant Staphylococcus aureus (MRSA) and serotypesof S pneumoniae that are not covered by the pneumococcalvaccine. Although chest radiographs are still a basic componentof the assessment of pneumonia, CT scans are increasinglybeing used to differentiate effusion from empyema and consolidationand to evaluate for pleural fluid loculations, lung abscesses,and lung necrosis. ß-Lactams, particularly extendedspectrumcephalosporins, remain an important cornerstone ofthe treatment of complicated pneumonia. In areas where community-acquired MRSA is a concern, empirical coverage for thispathogen should be considered in patients with a severe ornecrotizing pneumonia. (J Respir Dis. 2008;29(2):85-92)