Parapneumonic Effusion in Children

Hendaus, Mohamed A.; Janahi, Ibrahim

doi:10.1177/0009922815589917

Cited by 24 publications

(25 citation statements)

References 89 publications

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“…PPE is a common finding in patients with pneumonia, and children under 5 years of age with pneumococcal pneumonia develop PPE in approximately 50% of cases . Empirical treatment with antibiotics leads to resolution in most patients; however, some experience complications, such as empyema, necrosis, fistula, and lung abscess.…”

Section: Discussionmentioning

confidence: 99%

“…Pleural effusion is a common finding in patients with pneumonia and pneumococcus is the most frequent pathogen in community‐acquired pneumonia with parapneumonic effusion (PPE) and empyema. Currently, studies suggest that the incidence of pleural infection is increasing in both pediatric and adult populations without a clearly identifiable reason …”

Section: Introductionmentioning

confidence: 99%

“…Currently, studies suggest that the incidence of pleural infection is increasing in both pediatric and adult populations without a clearly identifiable reason. 2,3 Microbial cultures of pleural fluid (PF) are indicated for the detection of pathogens and to determine antimicrobial susceptibility.…”

Section: Introductionmentioning

confidence: 99%

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Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Pizzutti

Perez

Barbiero³

et al. 2019

Pediatric Pulmonology

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Objective To evaluate culture‐independent procedures (immunochromatography and quantitative polymerase chain reaction [qPCR]) in the detection and susceptibility of Streptococcus pneumoniae directly from culture‐negative pleural fluid (PF) in children. Method Detection of S. pneumoniae in PF of children with parapneumonic effusion and/or empyema by using two culture‐independent methods: an immunochromatographic membrane test (IMT) which identifies the pneumococcal C antigen, and a real‐time PCR test to detect pneumococcal genes lytA and pbp2b, a marker of susceptibility of β‐lactam agents, in PF samples. Results We tested 36 PF specimens and recorded the previous use of antimicrobials. In the final analysis, 34 samples were included. IMT and qPCR presented positive results in 23 (67.6%) and 24 (70.6%) of the samples, respectively, showing a moderate agreement (k = 0.518) between the two methods. From the 36 children included, 34 (94.4%) had antibiotic data available by the time when PFs were collected. Thirty‐four (100%) children had been given treatment before PF sampling, with 33 (97%) receiving β‐lactam antibiotics administered empirically. Of the 24 lytA real‐time positive samples, 21 (87.5%) were also positive for pbp2b, a marker of β‐lactam susceptibility. Conclusion The reduced sensitivity of culture for pneumococcal detection can be improved through the addition of IMT and qPCR analysis. The utility of qPCR combining detection of lytA and a marker of β‐lactam susceptibility should be explored further.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Pizzutti

Perez

Barbiero³

et al. 2019

Pediatric Pulmonology

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“…La probabilidad de realizar un diagnóstico etiológico del empiema mediante métodos microbiológicos convencionales es baja (1). En nuestro estudio, se logró identificar al menos un agente etiológico en el 39% (n= 7) de los casos, mediante una prueba de adenosina deaminasa por sospecha de infección tuberculosa.…”

Section: Análisis Y Discusiónunclassified

Toracoscopia en el manejo del empiema en niños

Angelo¹,

Romero²,

Ramı́rez³

et al. 2017

Pediatr

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“…Roughly 20%-40% of all patients with pneumonia have an associated PPE, whereas 1%-2% of pediatric patients with a diagnosis of pneumonia have a Stage 2 or 3 PPE [8,9]. Importantly, the incidence of empyema in children has been rising [10]: The incidence rate in children younger than four years has more than doubled in the last 20 years [11]. Despite the fact that allcause pneumonia hospitalizations have decreased since the introduction of the seven-valent pneumococcal conjugate vaccine, hospitalizations for pneumonia complicated by infected PPE have, according to National Inpatient Sample and Census data, increased from 3.5 cases per 100,000 children in 1996-1998 to 7.0 cases per 100,000 children in 2005-2007 [12].…”

mentioning

confidence: 99%

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

Richards

McAteer

Edwards

et al. 2017

Surgical Infections

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Background: Despite six randomized trials of various treatments for pediatric para-pneumonic effusion (PPE), management approaches differ. The purpose of this study was to gain insight into opinions on PPE treatment with the goal of designing a definitive trial to generate consensus intervention guidelines. Methods: To evaluate physician opinions regarding PPE management, we developed a survey based on input from a nationwide, multi-disciplinary advisory group that established content validity. The survey was disseminated broadly to six pediatric medicine and interventional radiology groups. Descriptive and w 2 statistics were calculated. Results: There were 741 respondents (response rate 13.1%), of whom 52.2% were surgeons, 15.2% hospitalists, 14.2% pulmonologists, 12.4% intensivists, and 6.0% interventional radiologists. Nearly all respondents (97.3%) reported caring primarily for pediatric patients. Eighty percent reported no written institutional treatment guidelines. Nearly all (90.3%) agreed that patients require antibiotics, but there was disagreement regarding their duration. Respondents also were split as to how often PPE required drainage. There were multiple absolute indications for drainage, including mediastinal shift on chest radiograph (67.2%) and loculations on imaging (47.7%). There were substantial differences in the preferred first-line methods of drainage based on the treating physician's specialty, with surgeons preferring tube thoracostomy and a fibrinolytic agent (42.0%) or videoassisted thoracoscopic surgery (41.6%), whereas interventional radiologists preferred either a tube thoracostomy (46.4%) or a tube thoracostomy with a fibrinolytic agent (39.3%) (p < 0.001). A large majority (75.3%) believed that the published evidence does not identify the optimal intervention. Conclusions: There is a lack of consensus regarding the optimal treatment of PPE. Respondents believed the published evidence is inconclusive and were willing to participate in a prospective trial. These findings will help inform the design of a randomized, pragmatic clinical trial to optimize PPE management.

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Parapneumonic Effusion in Children

Cited by 24 publications

References 89 publications

Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture‐independent methods?

Toracoscopia en el manejo del empiema en niños

Establishing Equipoise: National Survey of the Treatment of Pediatric Para-Pneumonic Effusion and Empyema

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