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Empyema in infancy and childhood
R Padmini1, S Srinivasan, R K Puri
1Department of Pediatrics, JIPMER, Pondicherry.
Abstract:
A study of 108 cases of empyema during 18 months period showed the incidence of empyema to be 2.17%. Staph. aureus (17.6%) was the common causative organism. Response to a combination of cloxacillin and gentamicin was better than that of crystalline penicillin and gentamicin. Only 30.3% cases needed intercostal drainage for more than 2 weeks. Almost 43% cases could be discharged by 3-4 weeks after hospitalisation and 38.1% by 30-57 days. The mortality rate was 12.1%. Among the survivors, excluding 8 children who left against medical advice, all had complete recovery excepting one child in whom AFB was isolated and who developed bronchiectasis and recurrent hemoptysis, inspite of antituberculous treatment. Age of the child, antibiotic combination given and nutritional status appear to be the main factors influencing the recovery and prognosis.
Insights
This study on empyema found Staphylococcus aureus as a common cause. Combination antibiotic therapy, particularly cloxacillin and gentamicin, improved outcomes, with most patients recovering well.
Area of Science:
- Pediatric Infectious Diseases
- Thoracic Surgery
- Clinical Microbiology
Background:
- Empyema, a serious thoracic infection, presents diagnostic and therapeutic challenges, particularly in pediatric populations.
- Understanding causative organisms and treatment efficacy is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence, causative organisms, treatment responses, and prognostic factors of empyema in a pediatric cohort.
- To compare the effectiveness of different antibiotic regimens in managing pediatric empyema.
Main Methods:
- Retrospective analysis of 108 pediatric empyema cases over an 18-month period.
- Identification of causative pathogens, primarily Staphylococcus aureus.
- Evaluation of treatment outcomes based on antibiotic combinations (cloxacillin/gentamicin vs. penicillin/gentamicin) and need for interventions like intercostal drainage.
Main Results:
- Empyema incidence was 2.17%, with Staphylococcus aureus being the most frequent pathogen (17.6%).
- Cloxacillin and gentamicin combination showed superior response compared to crystalline penicillin and gentamicin.
- Only 30.3% required prolonged intercostal drainage; mortality rate was 12.1%.
- Factors influencing recovery included age, antibiotic choice, and nutritional status.
Conclusions:
- Early diagnosis and appropriate antibiotic therapy, considering pathogen profile and patient factors, are key to successful empyema management.
- The combination of cloxacillin and gentamicin offers a promising therapeutic option for pediatric empyema.
- Further research into risk factors and long-term sequelae, such as bronchiectasis, is warranted.