[Antibiotic strategy in pleural empyema in children: Consensus by the DELPHI method]
M-C Leoni1, I Hau1, S Biscardi1
1Service de pédiatrie, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
Insights
Updated antibiotic guidelines are needed for childhood pleural empyema post-Prevenar 13. Experts reached consensus on conservative intravenous monotherapy but disagreed on specific drugs and severe cases.
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.
Introduction:
The evolution of the microbial epidemiology of pleuropulmonary infections complicating community-acquired pneumonia has resulted in a change in empirical or targeted antibiotic therapy in children in the post Prevenar 13 era. The three main pathogens involved in pleural empyema in children are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus.
Methods:
A questionnaire according to the DELPHI method was sent to experts in the field (paediatric pulmonologists and infectious disease specialists) in France with the purpose of reaching a consensus on the conservative antibiotic treatment of pleural empyema in children. Two rounds were completed as part of this DELPHI process.
Results:
Our work has shown that in the absence of clinical signs of severity, the prescription of an intravenous monotherapy is consensual but there is no agreement on the choice of drug to use. A consensus was also reached on treatment adjustment based on the results of blood cultures, the non-systematic use of a combination therapy, the need for continued oral therapy and the lack of impact of pleural drainage on infection control. On the other hand, after the second round of DELPHI, there was no consensus on the duration of intravenous antibiotic therapy and on the treatment of severe pleural empyema, especially when caused by Staphylococci.
Conclusions:
The result of this work highlights the needed for new French recommendations based on the evolution of microbial epidemiology in the post PCV13 era.
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