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Management of empyema in children
Adam Jaffé1, Ian M Balfour-Lynn
1Portex Respiratory Medicine Group, Great Ormond Street Hospital for Children, National Health System Trust and Institute of Child Health, London, UK. a.jaffe@ich.ucl.ac.uk
Abstract:
The incidence of empyema complicating community-acquired pneumonia is increasing and causes significant childhood morbidity. Pneumococcal infection remains the most common isolated cause in developed countries, with Staphylococcus aureus the predominant pathogen in the developing world. Newer molecular techniques utilizing the polymerase chain reaction have led to an increase in identification of causative bacteria, previously not isolated by conventional culture techniques. This remains an important epidemiological tool, and may help in guiding correct antibiotic use in the future. There are many treatment options, however, and the care a child currently receives is dependent on local practice, which is largely determined by availability of medical personnel and their preferences. Although there are many reported case series comparing treatment options, only two randomized controlled studies exist to guide treatment in children. There is an urgent need for this to be addressed, particularly with the introduction of relatively new surgical techniques such as video-assisted thorascopic surgery.
Insights
Childhood empyema, often caused by pneumococcal infection or Staphylococcus aureus, is rising. Advances in molecular techniques aid bacterial identification, but more research is needed to standardize treatment options for pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Childhood empyema complicating community-acquired pneumonia is an increasing concern with significant morbidity.
- Streptococcus pneumoniae is the most common cause in developed nations, while Staphylococcus aureus predominates in developing regions.
- Emerging molecular methods like polymerase chain reaction (PCR) enhance bacterial identification beyond traditional cultures.
Purpose of the Study:
- To highlight the rising incidence and etiological agents of childhood empyema.
- To underscore the limitations of current treatment guidelines due to a lack of robust clinical trials.
- To emphasize the need for standardized treatment protocols, especially with new surgical interventions.
Main Methods:
- Review of current literature on childhood empyema epidemiology and treatment.
- Discussion of advancements in molecular diagnostic techniques for pathogen identification.
- Analysis of existing treatment options and the paucity of high-level evidence.
Main Results:
- Increasing incidence of empyema in children.
- Identification of key bacterial pathogens (Streptococcus pneumoniae, Staphylococcus aureus).
- Limited number of randomized controlled trials (RCTs) guiding pediatric empyema management.
Conclusions:
- There is an urgent need for more research, including RCTs, to guide optimal treatment strategies for pediatric empyema.
- Standardization of care is crucial, considering variations in local practices and the advent of new surgical techniques like video-assisted thorascopic surgery (VATS).
- Improved diagnostic tools may aid in future antibiotic stewardship.
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