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Abstract
Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.
Highlights
Parapneumonic effusion or pleural empyema (PPE/PE) develop in about 40% of children with community-acquired pneumonia (CAP) requiring hospitalization [1]
Baseline characteristics of included PPE/PE patients are shown in Table 1, including comparison between patients managed with pleural tap alone and with surgical interventions
AMC can be narrowed to AMX in case of S. pneumoniae and S. pyogenes detection [5]
Summary
Parapneumonic effusion or pleural empyema (PPE/PE) develop in about 40% of children with community-acquired pneumonia (CAP) requiring hospitalization [1]. Sampling of pleural fluid in PPE/PE patients by simple pleural tap provides both diagnostic and therapeutic benefit [5]. The dynamic evolution of the inflammatory process in PPE/PE is divided into three stages, characterized as follows: stage 1, free-floating fluid, stage 2, fluid loculated by fibrous septations, and stage 3, consolidation (empyema) [8]. This staging and the size of the effusion influence the management of PPE/PE [5]. The indication and the impact of these interventions on duration of hospitalization and outcome are controversially discussed [1,9,10,11,12,13], and its clinical application often follows rather in-house experience-based protocols than evidence
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