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Empyema in children
1Department of Pediatric Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Insights
This study evaluated 52 patients with thoracic empyema, finding Staphylococcus aureus to be the most common cause. Treatment varied, with closed tube thoracostomy being frequently used for this serious condition.
Area of Science:
- Medicine
- Pulmonology
- Infectious Diseases
Background:
- Empyema, a serious complication of bacterial pneumonia, thoracic trauma, and surgery, remains a significant cause of morbidity and mortality globally.
- While potent antibiotics have reduced empyema mortality, it still poses a considerable health challenge, particularly in developing regions.
Purpose of the Study:
- To retrospectively evaluate the causes, diagnosis, treatment modalities, and long-term outcomes of thoracic empyema in 52 patients.
- To identify the most common etiological agents and assess the effectiveness of different management strategies.
Main Methods:
- Retrospective analysis of 52 patients diagnosed with thoracic empyema.
- Diagnosis confirmed via clinical suspicion, chest roentgenogram, and pleural fluid aspiration.
- Review of treatment approaches including antibiotics, thoracentesis, closed tube thoracostomy, open tube management, CT-guided catheter placement, and thoracotomy with decortication.
Main Results:
- Postpneumonic empyema was the most frequent cause (50/52 patients).
- Staphylococcus aureus was the predominant causative organism.
- Closed tube thoracostomy was a common initial treatment, with complications like abscess formation requiring further intervention in some cases.
Conclusions:
- Thoracic empyema, often postpneumonic, requires prompt diagnosis and varied treatment strategies.
- Effective management involves a combination of antimicrobial therapy and appropriate drainage techniques, with potential need for advanced interventions.
- Long-term follow-up is crucial to evaluate treatment outcomes and manage complications effectively.
Abstract:
Empyemas develop following bacterial pneumonias, thoracic trauma and surgery which are still among the common diseases, causing illness and death throughout the developing world. With the advent of potent antibiotics the mortality of empyema has been drastically reduced. In this study 52 patients (29 boys and 23 girls) with thoracic empyema were evaluated retrospectively. In this series the causes of empyema were postpneumonic in 50 patients, esophageal anastomotic leak in one patient, and thoracic trauma in one patient. The diagnosis was suspected clinically and by the finding of a pleural effusion on chest roentgenogram. Definitive diagnosis was confirmed by pleural aspiration which pus was obtained. Responsible organisms included; Staphylococcus aureus, Streptococcus pneumonia, Haemophilus influenza, pseudomonas, and Klebsiella. The most common is Staphylococcus aureus. The patients were treated in various ways; 14 patients were treated with antibiotics and thoracentesis, 38 patients were treated with a closed tube thoracostomy. Eight of 38 patients had the chest tube converted to an open empyema tubes for long term management. Fourteen of 38 patients developed abcess formation. Nine of 14 patients were treated with computed tomography guided catheter placement, five patients encountered thoracotomy and decortication. In this article, appropriate treatment and result of long-term follow-up of empyema were evaluated.