[Antibiotic strategy in pleural empyema in children: Consensus by the DELPHI method]

Area of Science:

• Pediatric Infectious Diseases
• Pulmonology
• Microbial Epidemiology

Background:

• Community-acquired pneumonia in children has evolving microbial patterns post-Prevenar 13 vaccination.
• Key pathogens in pediatric pleural empyema include Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus.

Purpose of the Study:

• To establish a consensus among French pediatric specialists on conservative antibiotic treatment for childhood pleural empyema.
• To address treatment strategies in the post-PCV13 era.

Main Methods:

• Utilized the DELPHI method with two rounds of questionnaires.
• Involved French pediatric pulmonologists and infectious disease specialists.

Main Results:

• Consensus achieved on intravenous monotherapy for uncomplicated cases, but drug choice remains debated.
• Agreement on adjusting therapy based on blood cultures, non-systematic combination therapy, oral continuation, and minimal impact of drainage.
• No consensus on IV therapy duration or management of severe, particularly Staphylococcal, empyema.

Conclusions:

• Highlights the need for new French clinical recommendations for pediatric pleural empyema.
• Recommendations should reflect the changing microbial epidemiology observed in the post-PCV13 era.