Empyema In Children Research Articles

EACTS expert consensus statement for surgical management of pleural empyema.

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.

An integrated care pathway for optimizing the investigation and management of pediatric pleural empyema

There are no reports of the use of an integrated care pathway (ICP) to facilitate the management of pleural empyema in children. Our aim is to assess pleural empyema management in our institute, to establish an ICP and to review the impact of this on the patient journey. Data were collected about management strategies, pain control and length of hospital stay from children admitted in 2000 with a diagnosis of pleural empyema. An integrated care pathway was developed to facilitate change in practice and provide greater consistency in management. This incorporated the use of intrapleural urokinase and guidelines on pain control. This was followed by data collection in 2004 to review the impact of the integrated care pathway. The 2000 review revealed that the majority of children (eight of 13) underwent a primary surgical intervention. Urokinase was not used. The median length of stay was 11.5 days (range 4–49 days). Implementation of the pathway led to a reduction in the number of children who underwent surgery (one of 18) with no adverse impact on clinical outcome. Median length of stay was 9 days (range 2–28 days). Children had a smoother patient journey, with prompter investigation and intervention. Children on the pathway had smaller chest drains inserted, received urokinase and had a clearly recorded analgesia strategy. Pleural empyema in childhood requires multi-disciplinary management. The implementation of an integrated care pathway is a valuable tool for managing a condition that requires multi-disciplinary input.

Initial treatment of septated parapneumonic empyema with drainage plus fibrinolytic agents is equally effective as video-assisted thoracoscopic surgery, and is suitable as first-line therapy.

It is thought that 0.6-2% of cases of pneumonia in children are complicated by parapneumonic empyema. The mainstay treatment options for empyema are pleural chest drainage plus fibrinolysis or video-assisted thoracoscopic surgery (VATS). Marhuenda et al. reported the results of a prospective, multicenter, clinical trial in which patients with parapneumonic empyema were randomized to either drainage plus urokinase or to VATS. That showed that the median postoperative stay, median hospital stay, and number of febrile days after treatment were not significantly different between the VATS group and the urokinase group. Only three other prospective randomized trials have been conducted with the same objective. The results in these studies had partially different among four trials. But all studies described that it is apparent that VATS is not more effective than fibrinolytic treatment. Intrapleural fibrinolytic treatment, which is much less invasive and lower inexpensive than VATS, is an effective and safe alternative to surgical treatment of complicated empyema. VATS would be reserved for patients who fail to respond to chemical/enzymatic debridement. We need additional randomized controlled trials with relevant inclusion/exclusion criteria and adequate sample sizes to determine the optimal therapy for parapneumonic-complicated empyema in children.

Is Urokinase or VATS Better for Treating Empyema in Children

Empyema is a common suppurative complication of bacterial pneumonia in children. Even with antibiotic treatment and chest tube placement for drainage

Treatment Trends and Outcomes in US Hospital Stays of Children With Empyema

Recently published practice guidelines continue to reflect uncertainty about the comparative effectiveness of various treatments for empyema in children. We describe treatment trends and outcomes in pediatric empyema using the most current nationally representative data. Using survey methods and Kids' Inpatient Databases from 1997 to 2009, we evaluated hospital stays in children 0-18 years of age. We used 2009 data to compare transfer-out rates and lengths of stay across various types of treatment, after adjusting for patient and hospital factors. From 1997 to 2009, empyema discharges steadily increased from 3.1 to 6.0 per 100,000 children (P < 0.001 for trend) and also were increasingly likely (P < 0.01) to be coded for: (1) at least 1 pleural drainage procedure (76.4-83.2%), (2) multiple drainage procedures (36.0-41.6%) and (3) home health care (8.7-15.0%). By 2009, video-assisted thoracoscopic surgery was more commonly coded than chest tube drainage and was associated with a lower transfer-out rate (0.6% vs. 10.1%, adjusted P < 0.001) but no reduction in mean length of stay [11.2 vs. 13.4 days, adjusted incidence rate ratio 0.95 (95% confidence interval: 0.88-1.04)] for children neither admitted nor discharged by transfer. US hospital stays for empyema in children not only continued to increase through 2009 but were also characterized by more intense procedural management. Outcomes results in this population-based study are consistent with practice guidelines and recommendations that recently endorsed chest tube drainage as an acceptable first treatment option for most children with empyema.

Risk factors for the development of pleural empyema in children

Pediatric pleural empyema has increased substantially over the past 20 years and reasons for this rise remain not fully explained. We investigated potential risk factors for the development of empyema in children by examining a cohort of patients with community-acquired pneumonia. Demographic, clinical, and socioeconomic characteristics, use of Ibuprofen prior to presentation and selected potential epidemiological risk factors were analyzed. Data were collected from a prospective etiological study of radiologically confirmed pneumonia in hospitalized children aged ≤16 years. One hundred sixty children were enrolled; 56% were male and 69% aged <5 years. Empyema complication developed in 40 (25%) children. Children with empyema were more frequently prescribed Ibuprofen prior to admission to hospital than those without (82% vs. 46.2%; OR 1.94, 97.5% credible interval 0.80-3.18). Bacterial infection was strongly associated with the development of empyema (OR 3.34, 97.5% credible interval 1.70-5.14). In contrast age, sex, maternal age, parental smoking, level of socioeconomic status, nursery attendance, asthma, household characteristics (bedrooms and number of occupants) were not significantly different between groups. In conclusion, children with pneumonia who developed empyema had more often received Ibuprofen prior to hospitalization and confirmed bacterial infection. We suggest a population-based study involving both primary and secondary care settings would help to investigate the role of Ibuprofen use in modulating the course of disease in children with pneumonia.

Severe Streptococcus pneumoniae 19A pneumonia with empyema in children vaccinated with pneumococcal conjugate vaccines

We read with great interest the article written by Ho et al on breakthrough pneumococcal 19A bacteremia in a child immunized with 10-valent pneumococcal conjugate vaccine (PCV10). We believe that breakthrough infections are inevitable because the protective efficacy of a given vaccine is not 100%. We would like to share our experience in severe breakthrough Streptococcus pneumoniae pneumonia with empyema after vaccinations with either PCV10 or PCV13 in Taiwan. Patient 1 was a previously healthy boy aged 2 years and 9 months, who was transferred to our hospital due to fever for 6 days and progressive dyspnea for 2 days. He had received 2 þ 1 doses of PCV10 at 8 months, 9 months, and 12 months of ages. On admission, he had high fever (rectal temperature 40 C) and tachypnea (respiratory rate 40e60/ min). Chest auscultation revealed crackles and a decreased breathing sound over the right upper lung field. Chest radiograph and computed tomography (CT) scan showed consolidation of the right upper lung fields and moderate right pleural fluid accumulation (Fig. 1A). The white blood cell count was 18.7 10/L (neutrophils 89%). The C-reactive protein concentration was 28.05 mg/dL

Editorial Commentary: A Tale of 2 Pneumococcal Vaccines

Pneumonia isthe leading infectious cause of death in all age groups. After 4 decades with just a single bacterial vaccine to prevent the disease, we now have conjugate pneumococcal vaccines licensed across most age groups to complement the 23-valent pneumococcal polysaccharide vaccine (PPV23),which has beenthe mainstay of efforts to protect persons aged >2 years from pneumococcal infections. Two articles in the current issue of Clinical Infectious Diseases from authors in adjacent European countries advance our knowledge on the effectiveness of these vaccines, although the clarity of their messages are starkly different. From Angoulvant et al in France [1], we see the extraordinary effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) just a year after introduction when given to infants without any catch-up program for older children. In an observational effectiveness study dedicated to the late Edouard Bingen, a giant in pediatric microbiology in France, his colleagues used PCV13 introduction to illustrate vaccine effectiveness and to provide insight into the pneumococcal etiology of community-acquired pneumonia (CAP) and empyema in children. Their article contains at least 5 interesting messages. First, they observed a rapid (within a year) reduction of 31% among nearly 2000 radiographically-confirmed pneumonias in the target age group of children <2 years seen in the emergency rooms of 8 hospitals across France. This study illustrates that surveillance of radiographicallyconfirmed pneumonia in a limited number of hospitals is a useful measure of PCV effectiveness, beyond surveillance for invasive pneumococcal disease (IPD) alone. The impact of PCV13 on IPD was recently demonstrated in a similar study in 8 US hospitals [2]. The observed reduction of several hundred episodes of radiographically-confirmed pneumonia in the French study contrasts with the small (4%) yield of pneumococcal cultures from blood from these patients and makes the argument that the evaluation of PCV impact may be possible in developing countries without microbiology facilities if radiography can be provided and performed in an adequate fashion with surveillance inplaceatemergency rooms of large urban hospitals.

Thoracic empyema in children: Clinical presentation, microbiology analysis and therapeutic options

Thoracic empyema is an accumulation of purulent fluid in the pleural space presenting as a complication of bacterial pneumonia. The aims of the study were to present the incidence, demographic results, clinical presentation, laboratory and microbiology results, imaging and the therapeutic options. From January 1992 until December 2009 we collected data of children hospitalized with empyema in our medical center in north of Israel. Empyema was found in 53 pediatric patients. The median age of the patients was 3 years and 31 (58%) were male. Forty one (77%) of the cases were diagnosed in the last nine years. Fever, cough and respiratory distress were the most frequent clinical signs. In 29 (55%) patients pleural effusion was found at admission. Chest ultrasound was performed in 44 (83%) of the patients. Causative organisms were confirmed by culture in 35 patients. Positive culture was found in 17 (32%) patients in the pleural fluid. Streptococcus pneumoniae was the leading pathogen. The drugs the patients received at admission were penicillin in 21 cases, cefuroxime in19 cases and ceftriaxone in 11 cases. During hospitalization a change of antibiotic therapy was required, using mainly ceftriaxone and clindamycin. The pleural purulent fluid was drained by video assisted thoracoscopy surgery in 34 (64%) patients. All the children recovered. The incidence of empyema as a complication of community acquired pneumonia had increased in the last decade in our region. Streptococcus pneumoniae is the most common pathogen. Third generation cephalosprins and clindamycin can be suggested as a good empiric treatment.

Long‐term recovery after parapneumonic empyema in children

The incidence of parapneumonic empyema in children has increased worldwide, but the long-term anatomical and functional consequences in the lungs after empyema are not known. We investigated the long-term outcome of childhood empyema in 26 patients by physical examination, chest radiograph and magnetic resonance image (MRI) of the lungs, and pulmonary function tests. At follow-up 3-19 years (mean 8 years) after empyema, all patients had normal findings in the physical examination. Spirometry was normal in 80% of patients, and evidence of obstructive airway disease was detected in 16%. Thirty-six percent of patients had abnormal findings in the chest radiograph and 92% in the MRI of the lungs. In six patients, the MRI revealed significant pleural scarring (extension longer than 1 cm). Thirteen patients (50%) reported persistent respiratory symptoms, such as impaired tolerance of physical activity or prolonged cough after a common cold. During the follow-up four patients suffered a second pneumonia. The long-term recovery of children with parapneumonic empyema is good, since most patients subsequently have normal lung function, chest radiograph, and clinical recovery. Half of the patients reported subjective respiratory symptoms and most patients had minor lung abnormalities, mostly pleural scars, detected in the MRI many years after empyema. However, as long-term impairment of lung function was rarely found, the clinical significance of the anatomical residues seen in the lung MRI seems to be minor.

Nested polymerase chain reaction (PCR) targeting 16S rDNA for bacterial identification in empyema

Background:Empyema in children causes significant morbidity and mortality. However, identification of organisms is a major concern.Objective:To detect bacterial pathogens in pus specimens of children with empyema by 16S rDNA nested polymerase chain reaction (PCR) and correlate it with culture and sensitivity.Method:Sixty-six children admitted to the paediatric ward with a diagnosis of empyema were enrolled prospectively. Aspirated pus was subjected to cytochemical examination, culture and sensitivity, and nested PCR targeting 16S rDNA using a universal eubacterial primer.Results:Mean (SD) age was 5·8 (1·8) years (range 1–13). Analysis of aspirated pus demonstrated total leucocyte count >1000×106/L, elevated protein (≧20 g/L) and decreased glucose (≤2·2 mmol/L) in 80·3%, 98·5% and 100%, respectively. Gram-positive cocci were detected in 29 (43·9%) and Gram-negative bacilli in two patients. Nested PCR for the presence of bacterial pathogens was positive in 50·0%, compared with 36·3% for culture.Conclusion:16S rDNA PCR improves rates of detection of bacteria in pleural fluid, and can detect bacterial species in a single assay as well as identifying unusual and unexpected causal agents.

S72 Paediatric pneumococcal empyema serotypes have not changed following introduction of the 13 valent pneumococcal vaccine

Introduction Pneumococcal infection is the leading cause of paediatric empyema in the UK. Prior to the change in the UK routine vaccination schedule from the seven valent conjugate pneumococcal vaccine (PCV-7) to the thirteen valent vaccine (PCV-13) in April 2010 four serotypes /serogroups–1, 3, 7A/F and 19A accounted for 75% of culture negative pneumococcal empyema in UK children. Antigen for these four serotypes is not present in PCV-7 but is present in PCV-13. We examined the impact of PCV-13 on the incidence of disease due to serotypes 1, 3, 7A/F and 19A using national surveillance data from the UK-ESPE study. Methods Pleural fluid samples were forwarded from admitting hospitals. Those that were pneumococcal PCR positive underwent non-culture serotyping using a multiplex antigen detection assay capable of detecting 14 serotypes/groups (1, 3, 4, 5, 6A/C, 6B, 7F/A, 8, 9V, 14, 18, 19A, 19F and 23F). Two time periods were analysed April 2008–April 2010 (PCV-7 era) and April 2010–April 2012 (PCV-13 era). Incidence rate ratios (IRR) were calculated for individual serotypes. Age distributions were compared by density plotting. Results 380 samples (median age 3.8 years) were tested in the two time periods (191 PCV-7 era, 189 PCV-13 era). No reduction in the incidence of empyema caused by the four main serotypes/groups (IRR: Serotype 1–0.79 95% CI (0.57–1.11), 3–0.91 (0.60–1.37), 7A/F–1.59 (0.85–3.04), 19A–2.42 (1.61–5.40)) was seen and 19A increased significantly. The age distribution of each serotype did not change between the two time periods. Discussion The introduction of PCV-13 has not yet been associated with any reduction in the incidence of vaccine serotype pneumococcal empyema in children in the UK, in contrast to the changes following the introduction of PCV-7. The factors contributing to this remain unclear but may include a predominantly PCV-7 vaccinated cohort, insufficient herd immunity, inadequate immunological response to vaccine antigen or on-going secular trends. Continuing surveillance is essential and will provide important data on future trends to better understand these complex processes.

Evaluation of management of postpneumonic empyema thoracis in children

Background Empyema is a well-known sequelae of pneumonia, which is increasingly being reported in children despite strict management. The appropriate management remains controversial. The aim of this study was to evaluate different management options of postpneumonic empyema in children. Materials and methods A total of 330 patients were reviewed between 2002 and 2012; their ages ranged from 1.25 to 15 years, with a median age of 4.3 years. The various management procedures included thoracentesis (n= 11), chest tube drainage (n= 229), chest tube drainage with intrapleural fibrinolytic therapy (n =117), video-assisted thoracoscopic surgery (VATS) (n =35), and thoracotomy because of a trapped lung noted on admissions and failed procedures (n =94). Results Variable success rates were noted as follows: tube thoracotomy (48.24%), fibrinolytic treatment (68.37%), and VATS (85.71%). Postoperative complications (11.14%) included wound infection (n = 10), atelectasis (n= 18), delayed expansion (n= 7), and need for reoperation (n= 2). Four patients died (1.21%), two of them following thoracotomy, one patient after fibrinolysis, and one patient following VATS. Patients treated with thoracotomy recovered completely. Conclusion New therapeutic modalities had variable success rates in children with postpneumonic empyema. Thoracotomy is still needed as a last resort for cases unresponsive to chemical fibrinolysis and following failed thoracoscopy. Keywords : decortication, empyema, fibrinolysis, thoracotomy

Pleural Empyema in Children: A Review of 85 Cases

We concluded that appropriate antibiotics with early closed-chest tube drainage are adequate to achieve clinical and physiologic resolution. Patients referred late to the hospital may require further surgical intervention. The long term prognosis is excellent.

Subdural Empyema in Children

Subdural Empyema in infants and children might be life threatening if not managed properly. A search of the Pub Med database was carried out using a combination of the following terms: Subdural empyema, children, and management. Neurosurgical textbooks were reviewed as well. The prevalence, etiology, clinical features, investigations and management of SDE are reviewed in this article. Conservative management with antibiotics and follow up imaging is recommended if there are no focal deficits, change in mental status or if the patient is responding well to antibiotics. Alternatively, craniotomy is warranted in addition to antibiotics therapy. The surgeon might opt for burr holes in case the patient is frail or in septic shock.

Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children

IntroductionWe previously reported a prospective, randomized trial comparing video-assisted thoracoscopic decortication (VATS) to fibrinolysis for the treatment of empyema. In that study no advantages to VATS were identified, although VATS resulted in significantly higher hospital charges. We subsequently implemented the algorithm from the trial utilizing primary fibrinolytic therapy in all children diagnosed with empyema. In this study, we reviewed our experience to examine the clinical efficacy of this protocol. MethodsAfter IRB approval, we conducted a retrospective review of all children diagnosed with empyema as all were treated with the fibrinolysis protocol utilized in the prospective trial since the completion of the trial. ResultsIn 102 consecutive patients treated with fibrinolysis, 16 patients (15.7%) required subsequent VATS. No patients were treated with initial VATS. No major side effects were seen from fibrinolytic therapy. Mean operative time for VATS after fibrinolysis was 62minutes. The length of stay after VATS was 5.9days. ConclusionsThe results of an evidence-based protocol using fibrinolysis to treat empyema have replicated the results of the trial that led to the implementation of the protocol. The pediatric empyema population can be successfully treated without an operation in the majority of cases.

Distribution of Streptococcus pneumoniae Serotypes That Cause Parapneumonic Empyema in Turkey

Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae that cause empyema in children. One hundred fifty-six children who were diagnosed with pneumonia complicated with empyema in 13 hospitals in seven geographic regions of Turkey between 2010 and 2012 were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogroups using a Bio-Plex multiplex antigen detection assay. The serotypes of S. pneumoniae were specified in 33 of 156 samples. The mean age ± the standard deviation of the 33 patients was 6.17 ± 3.54 years (range, 0.6 to 15 years). All of the children were unvaccinated according to the vaccination reports. Eighteen of the children were male, and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (non-PCV-7), serotype 1, serotype 5, and serotype 3, were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were codetected in two samples. The remaining non-PCV-7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverages of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes that cause empyema in order to have a better selection of pneumococcal vaccines.

THORACIC SURGERY Which technique is the best for the surgical management of empyema thoracis in children?

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Tander B, Bicakci U, Gunaydin M, et al. THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2013;10(2):130-132. doi:10.5114/kitp.2013.36132. APA Tander, B., Bicakci, U., Gunaydin, M., Demirel, D., Rizalar, R., & Ariturk, E. et al. (2013). THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 10(2), 130-132. https://doi.org/10.5114/kitp.2013.36132 Chicago Tander, Burak, Unal Bicakci, Mithat Gunaydin, Dilek Demirel, Riza Rizalar, Ender Ariturk, and Ferit Bernay. 2013. "THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?". Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery 10 (2): 130-132. doi:10.5114/kitp.2013.36132. Harvard Tander, B., Bicakci, U., Gunaydin, M., Demirel, D., Rizalar, R., Ariturk, E., and Bernay, F. (2013). THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, 10(2), pp.130-132. https://doi.org/10.5114/kitp.2013.36132 MLA Tander, Burak et al. "THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?." Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, vol. 10, no. 2, 2013, pp. 130-132. doi:10.5114/kitp.2013.36132. Vancouver Tander B, Bicakci U, Gunaydin M, Demirel D, Rizalar R, Ariturk E et al. THORACIC SURGERYWhich technique is the best for the surgical management of empyema thoracis in children?. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2013;10(2):130-132. doi:10.5114/kitp.2013.36132.

Empiema cerebral por Escherichia coli en un lactante de 5 meses: reporte de caso y revisión del tema

Medwave es una revista electrónica revisada por pares y de acceso gratuito, que contiene artículos originales de revisión sobre determinantes clínicos, sociales, políticos y económicos en salud, y de investigación en el ámbito clínico y biomédico. Medwave is an online-only, peer-reviewed and open Access biomedical general journal with original review articles con clinical, social, political and economic determinants of health, and research articles on clinical and biomedical aspects.

Comparison of invasive pneumococcal disease caused by serotype 19A and non-19A pneumococci in children: More empyema in serotype 19A invasive pneumococcal disease

To delineate whether serotype 19A invasive pneumococcal disease (IPD) comprised significantly more necrotizing pneumonia and empyema in children, we compared the clinical characteristics between serotype 19A and non-19A IPD. Between January 2007 and December 2011, cases of children with IPD who were treated at the National Taiwan University Hospital were reviewed. Patients were assigned to the 19A group or the non-19A group based on the serotype. Their demographic data, clinical course, laboratory results, diagnosis, complications, and sequelae were collected and analyzed. Overall, 27 patients were included in the 19A group and 29 patients in the non-19A group. Compared with non-19A group, serotype 19A tended to cause IPD in patients without major underlying diseases (p = 0.015). Bacteremia without pneumonia or meningitis was found more frequently in the non-19A group (45% vs. 11%, p = 0.01), and pneumonia with or without empyema occurred significantly more frequently in the 19A group (89% vs. 52%, p = 0.006). Patients in the19A group had longer duration of fever (12 vs. 3 days, p = 0.01), and required more intensive care (78% vs. 41%, p = 0.01) and more video-assisted thoracoscopic surgery (74% vs. 28%, p = 0.001). In comparison with the other serotypes, serotype 19A IPD has significantly more empyema which required more video-assisted thoracoscopic surgery and more intensive care.