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Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management
Galia Grisaru-Soen1, Michal Eisenstadt, Gideon Paret
1Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. galiag@post.tau.ac.il
Insights
Pediatric empyema, often caused by Streptococcus pneumoniae, leads to worse outcomes in children with pneumonia. Video-assisted thoracoscopy (VATS) did not shorten hospital stays compared to conventional treatment.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Pediatric empyema incidence is rising, causing significant childhood morbidity.
- Understanding risk factors and pathogens is crucial for effective management.
Purpose of the Study:
- To identify risk factors, clinical features, pathogens, and outcomes of pediatric empyema.
- To compare outcomes between children with and without empyema following community-acquired pneumonia (CAP).
Main Methods:
- Retrospective case-control study of children (2 months–18 years) hospitalized with CAP (2000-2009).
- Review of demographic data, symptoms, imaging, labs, and treatment from medical records.
- Analysis of microbiology databases for pathogen identification.
Main Results:
- Streptococcus pneumoniae was the most prevalent pathogen, with serotype 5 being most common.
- Children with empyema presented with more severe symptoms like prolonged fever, dyspnea, and chest pain.
- Most empyema cases (98%) required invasive procedures like chest tubes or VATS; hospitalization duration was similar for VATS and conventional treatment.
Conclusions:
- Streptococcus pneumoniae is the primary pathogen in pediatric CAP with or without empyema.
- Empyema significantly increases morbidity in children compared to CAP alone.
- Prospective studies on immunization's impact on pediatric empyema incidence are recommended.
Objective:
Pediatric empyema is increasing in incidence and continues to be a source of morbidity in children. Our objective was to determine the risk factors, clinical characteristics, distribution of the pathogens, and outcome of pediatric empyema in 2 Israeli pediatric medical centers.
Methods:
This was a retrospective case-control study on children aged 2 months to 18 years hospitalized with community-acquired pneumonia (CAP) in the pre-Prevnar era (2000-2009). Demographic data, presenting symptoms, physical examination findings, imaging studies, laboratory results, hospital course, medical treatment, and surgical interventions were reviewed from medical records and computerized microbiology databases.
Results:
One hundred ninety-one children comprised of 47 (24.9%) with parapneumonic empyema and 144(75.4%) without empyema. The symptoms and course of the children with empyema were substantially worse compared with patients without empyema. The most prevalent pathogen was Streptococcus pneumonia. The most common pneumococcal serotype was serotype 5, and 86% of the recovered S. pneumoniae were susceptible to penicillin. Children with empyema most commonly presented with prolonged fever, dyspnea (51%), and chest pain (17%). Forty-five children with empyema (98%) required a chest tube, fibrinolysis, or decortication with video-assisted thoracoscopy (VATS). Hospitalization stay was similar for children with empyema who underwent VATS and those who were treated conventionally.
Conclusions:
The most prevalent pathogen in children with CAP with and without empyema is S. pneumoniae. Children with empyema experience significantly more morbidity than did patients with CAP alone. In our experience, VATS apparently does not shorten the duration of hospitalization compared with conventional treatment. Immunization may affect the incidence of pediatric empyema and should be studied prospectively.
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