Antibiotic utilization based on primary treatment of pediatric empyema
Katherine W Gonzalez1, Brian G A Dalton1, Angela L Myers2
1Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Antibiotic use in pediatric empyema is lengthy and varies by treatment. Shorter antibiotic durations were seen with tissue plasminogen activator (tPA) fibrinolysis, but adverse reactions were common, suggesting a need for standardized, shorter protocols.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Chemical fibrinolysis is effective for pediatric empyema, but antibiotic use remains unevaluated.
- This study addresses antibiotic utilization across different pediatric empyema treatment modalities.
Purpose of the Study:
- To evaluate antibiotic utilization in pediatric empyema patients.
- To compare antibiotic therapy duration based on treatment type and presence of complications.
Main Methods:
- Retrospective review of 169 pediatric empyema patients (2005-2013).
- Analysis of antibiotic duration, cultures, necrosis/abscess presence, and adverse drug reactions.
- Exclusion of immunocompromised patients and those with additional infection foci.
Main Results:
- Patients receiving tissue plasminogen activator (tPA) had shorter parenteral antibiotic durations than VATS groups (P=0.04 to P<0.01).
- Necrosis or abscess presence significantly increased total antibiotic duration (P<0.01).
- 41% of patients experienced antibiotic-related adverse reactions.
Conclusions:
- Pediatric empyema antibiotic therapy is protracted and variable, influenced by treatment and complications.
- High rates of adverse reactions warrant consideration of standardized protocols with shorter antibiotic durations.
Background:
Chemical fibrinolysis has been shown to be as effective as surgical debridement for the treatment of pediatric empyema. However, no studies effectively evaluate antibiotic treatment. We evaluated antibiotic utilization among different treatments of pediatric empyema.
Methods:
This is a retrospective review of 169 empyema patients who underwent chemical and/or mechanical fibrinolysis at a dedicated children's hospital from 2005-2013. Data points included duration of therapy, cultures, presence of necrosis or abscess, and adverse drug reactions. Immunocompromised patients and those with additional foci of infection were excluded.
Results:
Twenty-seven patients underwent video-assisted thoracoscopic surgery (VATS), 123 had chemical fibrinolysis via tube thoracostomy with tissue plasminogen activator (tPA), and 19 had tPA followed by VATS. The mean (± standard deviation) duration of total antibiotic therapy was 25.7 ± 6.5 d; following a 24 h afebrile period of 19.4 ± 6.3 d. Patients who had tPA had a significantly shorter duration of parenteral antibiotic therapy when compared with primary VATS (9.2 ± 3.6 d versus 11.6 ± 5.5 d, P = 0.04) and VATS following tPA (9.2 ± 3.6 d versus 14.3 ± 8.1 d, P < 0.01). Patients with necrosis or abscess (n = 26) had an increased total duration of antibiotics (29.3 ± 5.7 d versus 25.1 ± 6.4 d, P < 0.01). Seventy patients (41%) had an adverse reaction related to antibiotic use.
Conclusions:
Patients with empyema currently receive a protracted variable course of antibiotic therapy influenced by primary treatment and the presence of necrosis or abscess. With a high incidence of adverse reactions, a standardized protocol with truncated treatment duration should be considered.
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