{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:15:11Z","timestamp":1788243311858,"version":"build-2803163510"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Necrotizing pneumonia (NP) in children requires etiology-dependent treatment, yet early etiological differentiation remains challenging due to the low sensitivity and slow turnaround of conventional microbiological methods. This study aimed to develop and validate a nomogram for predicting non-bacterial NP using routinely available clinical parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study enrolled children (&amp;lt;18\u202fyears) with contrast-enhanced computed tomography (CT)\u2013confirmed NP at Tianjin Children\u2019s Hospital (January 2020\u2013January 2025). Patients were classified as bacterial NP (BNP) or non-bacterial NP (NBNP) based on pathogen identification via culture, polymerase chain reaction (PCR), or targeted next-generation sequencing, and randomly split into training and validation sets (7:3). Predictors were selected by univariable screening followed by stepwise multivariable logistic regression, and a nomogram was constructed. Performance was assessed using receiver operating characteristic (ROC) analysis, calibration plots, and decision curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 149 children (76 BNP, 73 NBNP; training\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f104, validation\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f45), three independent predictors of NBNP were identified: fever duration (odds ratio [OR]\u202f=\u202f4.580,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.004), CRP (OR\u202f=\u202f0.272,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.009), and white blood cell count (WBC) (OR\u202f=\u202f0.257,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.025). The nomogram achieved an AUC of 0.816 (95% CI: 0.735\u20130.896) in the training cohort. Bootstrap internal validation (1,000 resamples) of the validation cohort yielded a bias-corrected AUC of 0.846 (95% CI, 0.732\u20130.959), confirming stable discriminative performance. Calibration was satisfactory (Hosmer\u2013Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.857 and 0.738), and decision curve analysis demonstrated positive net benefit.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A parsimonious nomogram based on fever duration, WBC count, and CRP level offers a practical bedside tool for early etiological differentiation of NP in children, potentially guiding timely pathogen-directed therapy before microbiological confirmation. External multicenter prospective validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1854223","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:35:18Z","timestamp":1788240918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a nomogram for differentiating bacterial from non-bacterial necrotizing pneumonia in children: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Mengyao","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University\/Tianjin Children's Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiafeng","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University\/Tianjin Children's Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanquan","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University\/Tianjin Children's Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University\/Tianjin Children's Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongsheng","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Children's Hospital, Tianjin University\/Tianjin Children's Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e71241","DOI":"10.1002\/ppul.71241","article-title":"Long-term outcomes of necrotizing pneumonia and parapneumonic effusion in children","volume":"60","author":"Oksay","year":"2025","journal-title":"Pediatr Pulmonol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"77","DOI":"10.2147\/idr.S498411","article-title":"Necrotizing bronchitis with airway obstruction due to macrolide-resistant Mycoplasma pneumoniae in a child: a case report","volume":"18","author":"Li","year":"2025","journal-title":"Infect Drug Resist"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1136\/jcp.47.11.973","article-title":"Adenovirus pulmonary infections identified by PCR and in situ hybridisation in bone marrow transplant 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Pediatr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"306","DOI":"10.3390\/jcm11020306","article-title":"Clinical characteristics of macrolide-refractory Mycoplasma pneumoniae pneumonia in Korean children: a multicenter retrospective study","volume":"11","author":"Choi","year":"2022","journal-title":"J Clin Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1606834","DOI":"10.3389\/fped.2025.1606834","article-title":"Lung consolidation absorption time in 238 pediatric cases of mycoplasma pneumoniae pneumonia","volume":"13","author":"Ou","year":"2025","journal-title":"Front Pediatr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"652","DOI":"10.3760\/cma.j.issn.0578-1310.2003.09.106","article-title":"T(H1) and T(H2) cells in children with mycoplasma pneumonia","volume":"41","author":"Hou","year":"2003","journal-title":"Zhonghua Er Ke Za Zhi"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s12890-023-02447-y","article-title":"Severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis","volume":"23","author":"Huang","year":"2023","journal-title":"BMC Pulm Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/inf.0000000000003340","article-title":"A tool to distinguish viral from bacterial pneumonia","volume":"41","author":"Tagarro","year":"2022","journal-title":"Pediatr Infect Dis J"}],"container-title":["Frontiers in 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