Parapneumonic empyema in children: a scoping review of the literature
Danilo Buonsenso1, Francesca Cusenza2, Lucrezia Passadore2
1Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. danilobuonsenso@gmail.com.
Insights
Pediatric empyema, pus in the pleural space, has unclear optimal management. This review found limited evidence comparing treatments, highlighting the need for better pediatric empyema trials.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Surgery
Background:
- Community-acquired pneumonia can lead to empyema, a serious pleural space infection in children.
- While not highly fatal, optimal management strategies for pediatric empyema remain debated.
- Current literature lacks robust comparisons of antimicrobial and surgical interventions.
Purpose of the Study:
- To map the existing literature on pediatric empyema.
- To identify study types, microbiology, therapies, and patient outcomes.
- To highlight gaps in knowledge regarding optimal pediatric empyema management.
Main Methods:
- Systematic search of PubMed and SCOPUS for studies on pediatric pleural empyema published since 2000.
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines.
- Inclusion of 127 studies encompassing diverse research designs and patient populations.
Main Results:
- Limited comparative studies exist, with only 15 comparing medical vs. surgical approaches and six comparing surgical interventions.
- Heterogeneity in study design, inclusion criteria, and treatments hinders definitive conclusions on optimal management.
- Overall mortality was 0.7% (78/10,896 children), with higher rates observed in Asia and Africa.
Conclusions:
- Significant gaps exist in understanding pediatric empyema etiology, optimal medical and surgical treatments, and the role of newer antibiotics.
- The current evidence base is insufficient to establish definitive treatment guidelines for pediatric empyema.
- Urgent need for well-designed, multi-country trials with rigorous criteria to address knowledge gaps in pediatric empyema management.
Abstract:
Community-acquired pneumonia can lead to a serious complication called empyema, which refers to pus within the pleural space. While it poses a significant threat to morbidity, particularly in children, it is fortunately not associated with high mortality rates. However, determining the best course of management for children, including decisions regarding antibiotic selection, administration methods, and treatment duration, remains a topic of ongoing debate. This scoping review aims to map the existing literature on empyema in children, including types of studies, microbiology, therapies (both antimicrobial and surgical) and patient outcomes. We systematically searched PubMed and SCOPUS using the terms "pediatric" (encompassing children aged 0 to 18 years) and "pleural empyema" to identify all relevant studies published since 2000. This search adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) checklist.A total of 127 studies was included. Overall, 15 attempted to compare medical treatments (alone or in combination with pleural drainage or fibrinolysis) with more invasive surgical approaches, and six studies compared diverse surgical interventions. However, the diversity of study designs makes it difficult to derive firm conclusions on the optimal approach to pediatric empyema. The heterogeneity in inclusion criteria, pharmacological/surgical approaches and settings limit the ability to draw definitive conclusions. Overall, 78 out of 10,896 children (0.7%) included in the review died, with mortality being higher in Asia and Africa. Our scoping review highlights important gaps regarding several aspects of empyema in children, including specific serotypes of the most common bacteria involved in the etiology, the optimal pharmacological and surgical approach, and the potential benefits of newer antibiotics with optimal lung penetration. New trials, designed on a multi-country level a higher number of patients and more rigorous inclusion criteria and designs, should be urgently funded.
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