Related Experiment Video
Updated: Oct 2, 2025
Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Characteristics, management and changing incidence of children with empyema in a paediatric intensive care unit
Rami Subhi1,2,3, Ben Gelbart1,3,4, Natasha Ching5,6,7,8
1Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Paediatric intensive care unit admissions for empyema increased after the 13-valent pneumococcal conjugate vaccine (PCV13). Despite this rise, patient severity and mortality decreased, suggesting improved management post-vaccination.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Empyema admissions to paediatric intensive care units (PICU) have shown an increase following the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13).
- Understanding the clinical characteristics, management strategies, and outcomes of pediatric empyema is crucial for optimizing patient care.
- Comparing empyema incidence and severity before and after PCV13 implementation provides insights into the vaccine's impact on disease epidemiology and clinical presentation.
Purpose of the Study:
- To describe the clinical features, management approaches, and outcomes of children with empyema admitted to a PICU.
- To compare the incidence of empyema in the post-PCV13 era with the pre-PCV13 period.
- To evaluate changes in illness severity and treatment outcomes for pediatric empyema following PCV13 introduction.
Main Methods:
- A retrospective study was conducted on patients under 18 years old admitted to The Royal Children's Hospital Melbourne PICU with empyema.
- Data were collected for two distinct periods: 2007-2010 (pre-PCV13) and 2016-2019 (post-PCV13).
- Incidence rates, clinical characteristics, management interventions (including video-assisted thoracoscopic surgery - VATS), and patient outcomes (severity scores, ventilation duration, mortality) were analyzed and compared between the two periods.
Main Results:
- In the post-PCV13 period (2016-2019), 71 children were admitted to PICU with empyema, representing 1.9% of all PICU admissions.
- While overall empyema hospitalizations decreased by 31%, PICU admissions for empyema increased 2.8-fold relative to all PICU admissions compared to the pre-PCV13 era.
- Patients in the post-PCV13 cohort showed a reduced probability of death (PIM2 score) and shorter duration of intubation compared to the pre-PCV13 cohort.
Conclusions:
- Despite an increased proportion of empyema admissions to PICU post-PCV13, patients presented with similar illness severity.
- A significant increase in empyema PICU admissions was observed in the post-PCV13 era compared to the pre-PCV13 era.
- Improvements in management, evidenced by reduced mortality probability and ventilation duration, were noted in the post-PCV13 period.
Aim:
Paediatric intensive care unit (PICU) admissions for empyema increased following the 13-valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13.
Methods:
Retrospective study of patients <18 years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019. We investigated the incidence of empyema during two time periods: 2007-2010 (pre-PCV13) and 2016-2019 (post-PCV13).
Results:
Seventy-one children (1.9% of all PICU admissions) were admitted to PICU with empyema between 2016 and 2019. Sixty-one (86%) had unilateral disease, 11 (16%) presented with shock and 44 (62%) were ventilated. Streptococcus pneumoniae and group A Streptococcus were the most commonly identified pathogens. Forty-five (63%) were managed with video-assisted thoracoscopic surgery (VATS). There was a 31% reduction in empyema hospitalisations as a proportion of all hospitalisations (IRR 0.69, 95% CI 0.59-0.8), but a 2.8-fold increase in empyema PICU admissions as a proportion of all PICU admissions (95% CI 2.2-3.5, P < 0.001). For the PICU cohort, this was accompanied by reduction in PIM2 probability of death (median 1% vs. 1.9%, P = 0.02) and duration of intubation (median 69 h vs. 126.5 h, P = 0.045).
Conclusions:
In children with empyema in PICU 62% required ventilation, 16% had features of shock and 63% received VATS. Empyema admissions, as a proportion of all PICU admissions, increased in the era post-PCV13 compared to pre-PCV13 despite no increase in illness severity at admission.
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Pneumonia III: Complications and Assessment
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:29Pneumonia II: Pathophysiology