Management of thoracic empyema in childhood

Abstract

A total of 160 cases of thoracic empyema admitted to our clinic between September 1988 and March 1994 have been analyzed retrospectively. There were 83 males and 77 females whose ages ranged from 25 days to 13 years. Cough (82%), fever (81%), and dyspnea (70%) were the most common presenting symptoms followed by chest pain, abdominal pain, and cyanosis. The preadmission history was often long (average 14 days). Following admission antibiotic therapy was initiated by parenteral administration of sulbactam-ampicillin, amikacin or netilmicin, and ornidazole or clindamycin and modified with vancomycin or piperracillin on the basis of culture and sensitivity reports. Fifty-four of 156 aerobic and 2 of 28 anaerobic cultures were positive.Staphylococcus aureus was the most common (57%) micro-organism isolated followed byPseudomonas aeroginosa andStreptococcus pneumoniae. In addition, 5 of 11Haemophilus influenzae latex-agglutination tests were positive. Two patients with pneumatocele formation received antibiotics as the only therapy. In the remaining patients, in addition to antibiotics treatment modalities included tube drainage (n = 111), decortication (n = 39), decortication with lobectomy or segmentectomy (n = 6), and pneumonectomy (n = 2). The overall mortality was 5%. Our results show that appropriate antibiotics and tube drainage provided effective control of childhood thoracic empyema, although in patients with serious respiratory distress and poor response to tube drainage, operative intervention is required.