Empyema Thoracis in Children: Can Pleural Fluid Culture Positivity Affect the Outcome?

Abstract

Background: Empyema thoracis in children continues to be a major problem with significant morbidity in developing countries despite recent advances in management. This study was aimed to evaluate the clinico-etiology and compare the outcomes of sterile and culture-positive pleural fluid empyema thoracis in North Indian children. Patients and Methods: A total of sixty admitted children satisfying the inclusion criteria were enrolled in the study from October 2018 to September 2020 with parental consent. Bacteriological etiology was confirmed by pleural fluid culture. Disease outcome was evaluated by duration of chest tube insertion, hospital stay, mortality, and successfully discharged patients. The outcomes were compared between patients with sterile and positive pleural fluid culture. Results: The average age of the patients was 4.72 ± 3.52 years with male preponderance (male/female ratio: 1.3:1). Forty-five percent of the patients were between 1 and 5 years. The most common predisposing factor was pneumonia. Fever and cough were the most common manifestations. Pleural fluid culture was positive in 28.3%, with Staphylococcus aureus being the most common organism isolated. Intercostal drainage (ICD) tube was used in 93.3% of the patients and was successful in 80%. The average period of ICD tube placement was 9 ± 4.18 days while hospital stay was 21 ± 9.12 days. Mortality was 1.7%. No statistical significant difference was found in outcomes between patients with sterile and culture-positive pleural fluid. Conclusions: S. aureus was the most common cause of empyema thoracis in this study. The high proportion of culture-negative specimens indicates that pleural fluid culture is not a satisfactory diagnostic tool to find the causative organism.