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Clinicobacteriological study of empyema thoracis in infants and children
S Ghosh1, C K Chakraborty, B D Chatterjee
1RMO-cum-Clinical Tutor (Paediatric Medicine), Dr BC Roy Memorial Hospital for Children, Calcutta.
Insights
This study on pediatric empyema thoracis found Staphylococcus aureus as the main cause, often linked to malnutrition and anemia. Effective treatment involved antibiotics like gentamicin and cloxacillin with chest tube drainage.
Area of Science:
- Pediatric infectious diseases
- Thoracic surgery
- Clinical microbiology
Background:
- Empyema thoracis is a serious thoracic infection.
- Pediatric cases present unique challenges in diagnosis and management.
- Understanding causative agents and risk factors is crucial for effective treatment.
Purpose of the Study:
- To investigate the clinical characteristics, aetiopathogens, and outcomes of empyema thoracis in pediatric patients.
- To evaluate the effectiveness of current therapeutic strategies.
Main Methods:
- Retrospective analysis of 41 pediatric empyema thoracis cases admitted between April 1985 and August 1987.
- Microbiological investigations to identify causative pathogens.
- Assessment of patient demographics, clinical presentation, treatment protocols, and outcomes.
Main Results:
- The majority of patients were male (65.9%) and under 2 years old (70.7%).
- Staphylococcus aureus was the predominant pathogen (68.3%), with resistance to penicillin and ampicillin but sensitivity to gentamicin, cloxacillin, and erythromycin.
- High rates of malnutrition (73.2%) and anemia (53.7%) were observed. Mortality was 17.1%.
Conclusions:
- Staphylococcus aureus is a primary cause of pediatric empyema thoracis, necessitating targeted antibiotic therapy.
- Malnutrition and anemia are significant comorbidities, impacting patient outcomes.
- Prompt management with antibiotics and chest tube drainage is essential, with an average hospital stay of 15.8 days.
Abstract:
Forty-one cases of empyema thoracis admitted in hospital during April, 1985 to August, 1987 were studied. Majority were males (65.9%) and were of less than 2 years of age (70.7%). Right side (60.9%) was predominantly involved. Abdominal distension (43.9%) was very characteristic, with other usual features like fever, cough and respiratory distress. A large majority of them were victims of malnutrition (73.2%) and anaemia (53.7%) with haemoglobin level ranging from 5-9 g/dl. Mortality was high (17.1%). Therapy with parenteral cloxacillin and gentamicin and continuous intercostal tube drainage accounted for loss of 15.8 bed days (average period of hospitalisation). Staph aureus was the principal aetiopathogen (68.3%). No anaerobe could be isolated. Strains of staphylococci were mostly resistant to penicillin and ampicillin but sensitive to gentamicin, cloxacillin and erythromycin.