engleski

Pleural empyema in children

Amazing increment of childhood empyema was registrated in Department of Pediatrics, University Hospital Split, during second half of 1998 and at the beginning of 1999. From 1987 to 1999 we treated 221 children with pleuropneumonia and 18 (8%) of them were complicated with empyema. The greatest incidence was from November to March: 10 (56%). Annual incidence of empyema was:1.4 ± 1.4 with increment in 1998 (4) and particularly in February 1999 (4), which was connected with epidemiological situation (epidemic of influenza). Symptoms had begun 6 ± 3 days before children were admitted in our unit (high temperature, cough, vomiting, breathlessness). Children were aged 7.5 ±5.4 (range 1 to 15 years), with double predominance of boys (M : F = 12 : 6). A diagnostic pleural tap was performed in all of the children. Streptococcus pneumoniae (SP) was identified by pleural culture in one patient, Stenotrophomonas maltophilia in another one. Pseudomonas aeruginosa was isolated from drainage tube in 3 cases. Staphylococcus aureus was found from blood culture in 2 cases, SP in 1, Haemophilus influenzae in 1, and in 1 case Streptococcus viridans and Enterobacter gergoviae were isolated. Children were treated by intravenous antibiotics. 16 patients had chest tube drainage and 7 of them had thoracotomy and postoperative drainage. Hospital stay was: 43 ± 17 days. Final result was successful in all our patients, with mild residual adhesions. Conclusion: Surprising increment in the incidence of childhood empyema in the second half of 1998 and at the beginning of 1999 is connected with late therapy, late drainage of pleural fluid and lower dosage of antibiotics. Early chest tube drainage or thoracotomy with evacuation of purulent collection, due to intravenous antibiotic treatment accelerate final recovering and cut down time of hospitalisation.

Pleural empyema; Children; Treatment

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