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Pneumococcal pleural empyemas in children

W Hardie1, R Bokulic, V F Garcia

  • 1Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio 45229-3039, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 1, 1996
PubMed
Summary

Pleural empyema in children is rare but increasing, often caused by drug-resistant Streptococcus pneumoniae. Most cases occurred in winter, with a median patient age of 7 years.

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Area of Science:

  • Pediatric Infectious Diseases
  • Pulmonary Medicine
  • Epidemiology

Background:

  • Pleural empyema is an uncommon complication of childhood pneumonia.
  • Previous studies indicated empyema predominantly affected infants.

Purpose of the Study:

  • To investigate the incidence, characteristics, and causative agents of pediatric pleural empyema.
  • To assess antimicrobial resistance patterns in isolated pathogens.

Main Methods:

  • Retrospective review of 50 pediatric pleural empyema cases from 1988-1994.
  • Analysis of patient demographics, clinical presentation, treatment, and microbiological data.
  • Antimicrobial susceptibility testing of Streptococcus pneumoniae isolates.

Main Results:

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  • Empyema incidence increased significantly in the last year of the study (3.3 per 100,000).
  • Peak incidence occurred in winter (50% of cases).
  • Median patient age was 7 years, with most cases community-acquired and few underlying illnesses.
  • Streptococcus pneumoniae was the most common pathogen (40%), with significant resistance to cefotaxime (23%) and chloramphenicol (31%).
  • No deaths were reported, but 56% required thoracotomy with decortication.

Conclusions:

  • Pediatric pleural empyema incidence is rising, with a shift towards older children.
  • Drug-resistant Streptococcus pneumoniae is an emerging cause of pediatric empyema.
  • Prompt diagnosis and treatment, including surgical intervention, are crucial for favorable outcomes.