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Empyema in children: clinical course and long-term follow-up
Insights
Pediatric empyema, particularly loculated empyema, can be successfully treated with antibiotics and chest tube drainage. Most children experience excellent long-term outcomes with minimal residual effects.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Infectious Diseases
Background:
- Empyema in children, especially loculated empyema, presents a significant clinical challenge.
- Identifying causative pathogens is crucial for effective treatment strategies.
Purpose of the Study:
- To evaluate the clinical course and long-term outcomes of pediatric empyema.
- To assess the efficacy of chest tube drainage and antibiotic therapy.
Main Methods:
- Retrospective study of 16 children (1 month to 15 years) with empyema.
- Analysis of clinical data, pathogen identification, imaging, and pulmonary function tests.
- Evaluation of treatment outcomes including hospitalization duration and need for surgical intervention.
Main Results:
- Haemophilus influenzae type b was the most common pathogen.
- Chest tube drainage was effective, yielding significant fluid within three days.
- Most patients required only chest tube drainage; three needed open thoracotomy.
- Long-term follow-up revealed normal physical examinations and pulmonary function in most patients.
Conclusions:
- Antibiotics combined with chest tube drainage offer successful treatment for pediatric loculated empyema.
- Open drainage and further surgery are rarely necessary.
- Excellent long-term outcomes and recovery are expected for most children.
Abstract:
Sixteen patients, aged 1 month to 15 years, were studied to determine the clinical course and long-term outcome of empyema in previously healthy children. The pathogens responsible were Haemophilus influenzae type b (seven patients), Staphylococcus aureus (five patients), Streptococcus pneumoniae (three patients), and viridans group Streptococcus (one patient). All patients had loculated fluid showing on chest roentgenographs. Chest tube drainage yielded 20 to 1,495 mL (mean 293 mL) during the first three days, accounting for 83% of total drainage. Chest tubes were removed after three to 17 days (mean ten days). Only slight roentgenographic improvement showed during chest tube drainage. Three patients required an open thoracotomy because of an unsatisfactory clinical response. Hospitalization ranged from eight to 77 days (mean 25 days). All patients had residual pleural thickening shown on chest roentgenographs taken at discharge. Thirteen patients were seen 5 to 140 months (mean 66 months) after discharge. Findings from physical examination were normal in 12 of the 13 patients. Pulmonary function tests in ten of the 13 patients revealed (mean percent predicted +/- 1 SD): vital capacity 92 +/- 12, residual volume 85 +/- 31, total lung capacity 92 +/- 13, peak flow rate 96 +/- 17, forced expiratory volume in 1 second 90 +/- 13, and maximal mid-expiratory flow rate 93 +/- 25. In all but one patient, findings on chest roentgenograms were normal or showed slight pleural thickening. Children with loculated empyema can be treated successfully with antibiotics and chest tube drainage. Few patients require open drainage, and further surgery is rarely required. The long-term outcome is excellent.