Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia

Abstract

Aims: To study the clinical and microbial profile of childhood empyema in South Asia and to identify the changes over the past three decades. Methods: A total of 265 children (aged 1 month to 12 years) with empyema admitted to the Advanced Pediatric Center, PGIMER, Chandigarh, India in 1989-98, were reviewed retrospectively. Results and Conclusions: One third of children were under 5. Culture positivity had decreased significantly (48% v 75%) over the years. Staphylococcus aureus continues to be the commonest (77%) aetiological agent; clustering was seen during hot and humid months (46%). Culture positive Streptococcus pneumoniae cases also decreased (9% v 27%); all were seen during the winter and spring season. Gram negative rods grew in more patients (11% v 7%). Community acquired methicillin resistant S aureus (MRSA) was isolated in three patients. Most children (93%) were treated with parenteral cloxacillin and an aminoglycoside. Tube drainage (TD) was used in 92% of fibropurulent cases, and was successful in 79%. Of 48 patients with failed TD, 12 needed decortication; limited thoracotomy was sufficient in the remaining 36. Surgery was mainly required by children with persistent pleural sepsis after 10 days of TD. Delaying surgery until 14 days had a significantly higher potential of requiring decortication. Early change to oral antibiotics (after 1-2 weeks of parenteral therapy) reduced the hospital stay significantly (17+7 v 23+7 days) without compromising long term outcome. Twenty two patients presenting late in the chronic stage underwent decortication at admission.

Empyema Thoracis: Analysis of 150 Cases from a Tertiary Care Centre in North East India

“…The present analysis shows that most cases were in children below 5 years, thus confirming that empyema may be more likely to occur in young children. Previous studies from India also show similar results [10]. The average age of presentation in the present study was similar to previous studies [11][12][13].…”

“…Yield of culture was significantly lower (32%) compared to reports from other developing countries (48-82%) [10,[14][15][16][17][18]. It could be due to prior use of antibiotics and late referral.…”

Empyema Thoracis in Children: A Clinical Study

“…Previous studies suggest a success rate of 61-100% with chest tube drainage and antibiotics. (39,40) These treatment outcome were similar to other studies. (21,29) A meta-analysis comparing operative and non-operative procedures has also concluded that conservative management leads to recovery in more than 76% of the patients.…”

Update on Antibacterial Resistance in Low-Income Countries: Factors Favoring the Emergence of Resistance

“…In a recent study from India it was shown that of the 250 pyoderma cases from the community 80.8% was due to S. aureus, of which 10.9% was MRSA; 54.4% of the patients carried S. aureus in their nares, 11.8% being resistant to methicillin [131]. Among agents of community acquired thoracic empyema of children in an Indian study S. aureus was the most frequently identified pathogen and from 3 children MRSA was isolated [132]. Unfortunately, none of these studies has been complemented with molecular typing data to confirm typical CA-MRSA genotypes and some use only phenotypic surrogate markers, as clindamycin susceptibility, to define "community-acquired-like" isolates [133].…”