Empyema Thoracis In Children Research Articles

Microbiological study of empyema thoracis among children in a tertiary care hospital

Background: Empyema thoracis is a condition resulting in the accumulation of purulent fluid in the pleural cavity. It is a common source of illness among young children and is the most common sequela of bacterial pneumonia. Aims and Objectives: This study was to determine the clinico-microbiological profile, causative agents, and antimicrobial susceptibility patterns of the isolates of the study population. Materials and Methods: Prospective observational study was done in the Department of Microbiology, S. C. B. M. C. H., Cuttack. The study group comprised a total of 105 cases of empyema thoracis between the age group of 0–14 years, diagnosed by aspiration of pus from the pleural space. Complete histories of cases in detail were noted. Results: A total of 41% of patients were in the age group of 5–9 years with M: F ratio of 1.1:1. Maximum cases 36 (34.3%) were seen in the spring season. Fever, cough, and breathlessness were the most common complaints. Bronchopneumonia 56 (53.3%), impetigo, and skin lesions 29 (27.6%) were the major predisposing factors. Right-side empyema 71 (67.6%) was more common than the left side 34 (32.4%). Culture revealed Staphylococcus aureus as the most common etiologic agent 26 (36.1%), of which 30.8% were methicillin-resistant S. aureus, followed by Mycobacterium tuberculosis complex 13 (18.1%). Finally, 103 (98.2%) empyema cases were recovered by antibiotics and tube thoracostomy. Conclusion: Empyema thoracis is more prevalent in the lower socioeconomic population which can be prevented by an early diagnosis of pneumonia. Effective methods to treat empyema thoracis in children include the administration of proper antibiotics and tube thoracostomy in resource-poor settings.

Empyema Thoracis in Children – Tailored Surgical Therapy for Late Referrals: A Single Unit Experience – Study in Suburban Mumbai

Empyema Thoracis in Children – Tailored Surgical Therapy for Late Referrals: A Single Unit Experience – Study in Suburban Mumbai

Empyema Thoracis in children: A Five-Year Analysis from a Tertiary Care Center in Eastern Nepal

Introduction: Complicated community-acquired pneumonia resulting in empyema thoracis remains the largest single cause of morbidity and mortality worldwide in children. This study was carried out to evaluate the clinical profile, associated complications and outcome of empyema thoracis in children. Methods: A retrospective study was conducted in the Department of Paediatrics at a tertiary care center in Eastern Nepal. A total of 106 children were managed with the diagnosis of complicated pneumonia with effusion or empyema thoracis from March 2017 to February 2021 (Five years). Only those patients who had clinico-radiological evidence of pleural effusion or empyema thoracis and received treatment with or without intercostal chest tube drainage (ICD) as the initial procedure were enrolled in the study. Besides supportive treatments and antibiotics; streptokinase was instilled intrapleurally in all the patients for three days. Patients who did not respond underwent VATS / decortication. Results: Majority of the children (60.19%) were below five years of age and were males (73.58%). Majority (55.67%) had a right-sided pleural effusion and fever was the predominant symptom (55.66%) at presentation. The pleural fluid culture was sterile in more than half (55.66%) of the patients with Staphylococcus aureus grown in 33.96%. The three most common complications were subcutaneous emphysema, thickened pleura, and pyo-pneumothorax. The success rate of medical management was 83.96% and the mortality was low (2.84%). Conclusions: The success rate of conservative management with antimicrobial therapy, intercostal drainage and fibrinolytics in this study was high (83.96%) with no major adverse effects of fibrinolytic therapy in empyema thoracis.

Clinico-epidemiological profile and outcome of pleural effusion of infective etiology in children from central India

Background: Empyema thoracis is an accumulation of pus in the pleural space. It is estimated that 0.6% of childhood pneumonias progress to empyema, affecting 3.3/1,00,000 children. Various treatment options available include antibiotics alone or with chest tube drainage, intrapleural fibrinolytics, video-assisted thoracoscopic surgery, and open decortications. Aims and Objectives: (1) The objective of the study was to study clinico-epidemiological and lab profile of pediatric patients with pleural effusion of infective etiology and (2) to study outcome and short term follow-up. Materials and Methods: Prospective observational study conducted from June 2020 to May 2021 at the pediatric department of a tertiary care hospital, central India. Inclusion criteria: Children between 6 months and 14 years diagnosed with pleural effusion clinically and radiologically. Exclusion criteria: Effusion of traumatic or malignant origin. Detailed history, examination, and relevant investigations were recorded. Data were compiled and analyzed. Patients were treated with intercostal drainage, antibiotics and were referred for surgical intervention wherever necessary. Results: Thirty-five patients were included in this study. The mean age of the patients was 4.4 years. Fever (100%), cough (88.5%) and breathlessness (65.7%) were the most common symptoms found at admission. Staphylococcus aureus was the most common organism isolated from pleural fluid. In the present study, 77% (27) patients were treated with ICD and antibiotics, 11.5% patients required surgical intervention, and 11.5% patients responded to antibiotics alone. The mortality rate in our study was 5.7% and the rest of the patients were successfully discharged and followed up. Conclusion: Antibiotics and tube thoracostomy are effective methods of treating pyogenic empyema thoracis in children in resource poor settings.

Role of Primary Vats for the Treatment of Empyema Thoracis in Children

Role of Primary Vats for the Treatment of Empyema Thoracis in Children

Management of chronic empyema thoracis in children, a single center retrospective observational study

Abstract: Background: Chronic empyema thoracis (CET) is common in developing and developed countries despite advancement in diagnostic and therapeutic technologies. Some of the cases of CET can be managed with antibiotics and tube drainage alone, some of them managed with less extensive surgical procedure like video-assisted thoracoscopic surgery (VATS) or open decortication alone, while some of the complicated cases need extensive decortication and debridement of necrotic lung tissue or lobectomy. Our aim is to present our experience of management of cases of chronic empyema thoracis in children. Methods and Material: This is a retrospective observational study of cases, managed at tertiary care center with chronic empyema thoracis. Records of cases of CET admitted, referred or transferred to department of pediatric surgery at our center over last three years were studied. Demographic data, clinical, radiological profile, surgical/ non-surgical intervention, hospital stay, aetiology, outcome was analysed. Follow up was up to the last recorded outpatient visit. This study is a retrospective observational study with small number of cases statistical tool are not used to draw any statistical interference. Results: Twenty-nine cases with median age 3 years, male to female ratio was 25:4 were admitted over three years. Pre-operative bronchopleural fistula was seen in four. Five cases were managed conservatively, twenty underwent decortication alone while four cases required decortication along with lobectomy. Tuberculosis was detected in three cases. A pyogenic organism was identified in ten cases only. Post-operative ventilation was required in three patients. There was no mortality. All thrived well at 12-18 months follow up. Conclusions: Management of chronic empyema should be case based. Cases of CET in children can managed with conservative (with appropriate drainage of cavity, proper antibiotics, and nutritional build-up of child), thoracotomy and decortications alone or some time removal of disease lung also required depending on clinical and radiological finding of cases.

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

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.

Empyema thoracis in children: analysis from a tertiary care center

Background: Empyema thoracis refers to infection and pus formation within the pleural space in the thorax. It is estimated that 0.6% of childhood pneumonia’s progress to empyema, affecting 3.3 per 100000 children. The purpose of this study was to analyse the clinical and bacteriological profile, outcome of empyema in children with reference to intercostal drainage/tube thoracostomy (ICD/TT) and video assisted thoracoscopic surgery (VATS).Methods: A hospital based prospective comparative study was conducted on 61 children diagnosed with empyema thoracis according to ICD-10 code J869 between 6 months to 18 years of age admitted to K. G. P. children hospital, Vadodara over a period of 20 months from September 2018 to May 2020.Results: Most of patients (63.9%) were seen in age group of 1-5 years. Fever (100%), cough (99%) and breathlessness (85%) were the commonest presenting features. Pleural fluid culture was positive in (28%) of patients and Staphylococcus aureus (11.5%) was the most frequent organism isolated from pleural fluid. The mean duration of ICU stays, the mean duration of hospital stays and time taken for removal of ICD was less VATS group with statistically significant difference.Conclusions: Empyema in children causes significant morbidity which can be reduced by appropriate treatment of bacterial pneumonia. ICD and antibiotics are effective method to facilitate drainage and resolution of empyema in resource poor settings. VATS is effective treatment for empyema when presented with stage 2 and stage 3 empyema having multiple loculation, which decreases duration of hospital treatment.

Pediatric empyema thoracis: our surgical experience

Incidence of empyema is increasing despite various treatment modalities available. Management of pediatric empyema remains a challenge due to factors like malnutrition, poverty, TB, delay in early intervention and incomplete treatment course. It is necessary to address these issues at ground level. A short 2-year prospective study was carried out at a tertiary care teaching hospital where 17 consecutive cases of pediatric empyema were managed. Among 17 cases, all patients intercostal tube drainage (ICD) was required. Six patients underwent surgical interventions [2 video-assisted thoracoscopic surgery (VATS) and 4 open thoracotomies] while 11 were managed on ICD and antibiotics. Fibrinolytic therapy was not administered in any case. Follow-up showed good lung expansion with apparent rib crowding in 3 cases and no mortality. Majority of empyema in children are post pneumonic. Chest tube drainage, antibiotics along with intrapleural fibrinolytic is a safe and effective method of treating empyema thoracis in children in resource- poor settings and can reduce the need for invasive interventions.

Empyema in Children - Is Primary VATS the Preferred Strategy

Introduction: Empyema thoracis (ET) is an accumulation of pus in the pleural space. Considering the advantages of Video Assisted Thoracoscopic surgery (VATS), including reduced length of hospitalisation, lower postoperative morbidity and mortality, VATS is the treatment of choice for cases of stage 3 empyema. The objective of this study was to study the age-sex profile, clinical presentation, etiologic agents, management and the overall treatment outcome of empyema thoracis after early VATS in children.
 Methods: This was a retrospective observational study, conducted in the Department of Paediatrics, Rangadore Memorial Hospital, Bangalore, from November 2018 to March 2020. All children in the age group of 0 to 18 years diagnosed to have pyogenic empyema and presenting in stage 1 and 2 during the study period were included in the study. In the present study, 15 children were found to be having empyema (stage 1 and 2).
 Results: Majority of patients (66.6%) were seen in the age group of one to five years. Fever (100%), breathlessness (66.66%), and cough (80%) were the commonest presenting features. Bacteriological isolation was possible only in three cases (20%). Patients were treated with antibiotics and primary VATS in majority of cases (55.33%). Average duration of hospital stay in VATS group was 12.11 days.
 Conclusions: Empyema thoracis mainly affects younger children. Common presenting features are fever, difficulty in breathing and cough. Appropriate antibiotics and early VATS may be acceptable modality for management of pyogenic empyema thoracis in children.

Clinico-bacteriological Profile and Outcome of Empyema Thoracis in Children at a Tertiary Care Hospital of Central Nepal

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay in early diagnosis, failure to institute appropriate antimicrobial therapy, multidrug resistant organisms, malnutrition, comorbidities, poor health seeking behaviour and high treatment cost burden contribute to increased morbidity in children. The available treatment options include intravenous broad-spectrum antibiotics either alone or in combination with surgical procedure (thoracocentesis, chest tube drainage, fibrinolytic therapy, decortications with video assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.

Pediatric Empyema Thoracis: Jabalpur Image-Based Staging and Stage-Directed Decision-Making Algorithm

Pneumonia in the pediatric age group is common and it can commonly progress to pediatric empyema thoracis (PET). The American Thoracic Society has described three stages of PET which have been the following: exudative, fibrinopurulent, and organized. We describe a new Jabalpur image-based staging system for empyema thoracis in children which has allowed focused intervention and improved outcomes. Pre-empted focused observation, gaps in the treatment and outcomes, and the triangulation of these resulted in the evolution of a new, image-based staging system for pediatric empyema thoracis. From 2009 to 2014, our team was a participant-observer of the usual practices to treat children up to 18 years of age with pneumonia who developed empyema. The prevalent classification into exudative, fibrinopurulent, and organized empyema was treated as per practice. Patients with chronic empyema, empyema necessitans, and tubercular and those with incomplete data were excluded. A staging system purely based on ultrasound (US) and computed tomography (CT) findings was evolved, and we call it Jabalpur image-based staging (JIBS) system for pediatric empyema thoracis. A decision-making algorithm was further evolved using the JIBS system to provide stage-directed treatment. This staging system and algorithm after a pilot run was prospectively applied to a set of patients accrued from January 2015 to December 2019 with PET which was strictly allocated as per new evolved staging and treated with discrete choices by all the methods inclusive of general supportive care, nutritional support, tube drainage, and open and video-assisted thoracoscopic surgery (VATS). The successful early outcome was defined statistically significant reduction of mean ICTD days, the number of CXRs, and the mean hospital days, which reflects earlier recovery. The long-term successful outcome was defined as the absence of fever, breathlessness, and adequate weight gain (according to age) at a minimum follow-up of 3 months. On the prospective evaluation of JIBS and the stage-directed decision-making algorithm on a set of 187 children accrued from January 2015 to December 2019, there was a significant improvement in the success of drainage and the number of VATS procedures, and their success significantly improved. There was a significant reduction in mean preoperative stay, mean intercostal tube drainage (ICTD) days, the number of chest x-rays (CXRs), mean hospital stay, and the number of open procedures in the prospective group. Accuracy of a new staging system to identify exudative, fibrinopurulent, and organized stages of PET was found to be 94.65%, 94.65%, and 97.86% respectively. The long-term successful outcome was observed in 179 (95.72%) children while 8 patients had chest deformity and a minimum secondary scoliosis which was addressed with physiotherapy. This study proposes a simple image-based staging system and stage-directed decision-making algorithm for empyema thoracis in children, which sharply defines the stages and allows the selection of appropriate surgical modality in cases of PET.

Open pleural decortication for the late stage empyema thoracis in children: a retrospective observational study from a tertiary hospital of eastern Nepal.

The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.

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Thoracoscopy in stage 3 empyema thoracis in children – A safe and feasible alternative to thoracotomy

BackgroundEven though the role of thoracoscopy is well defined in Stage 2 empyema thoracis and is very popular, its role in the management of advanced empyema is still unclear. The technical difficulties and the potential complications are the principal reasons for the hesitancy in attempting video assisted thoracoscopic surgery (VATS) in advanced stages. MethodsWe prospectively studied the safety, feasibility and effectiveness of VATS for decortication in Stage 3 empyema. ResultsIn the 61 cases that we attempted VATS over the last 7 years, we could complete the procedure in 45 patients (73.77%). Four children among them required re-do procedure later for persistent problems. Conversion to thoracotomy was needed in 16 patients (26.23%). The post-operative hospital stay of patients who underwent primary VATS decortication was significantly less when compared to patients requiring conversion (p < 0.0001). ConclusionThoracoscopy is a safe, feasible and effective option even in advanced empyema thoracis and should be offered in centers with adequate expertise and set up. Level of evidenceLevel II.

Managing Postpneumonic Empyema Thoracis in Children: Comparison of Different Treatment Options

Objectives: To compare various treatment methods of postpneumonic empyema (PPE) in children. Methods: Six hundred eighty one (302 females and 379 males) pediatric PPE patients were studied at two different centers between 2000 and 2016. The average age was 4.8 years that ranged from 30 days to 15 years. The patients were considered in six groups. The initial treatments, thoracentesis (group A), chest tube drainage (group B), fibrinolytic therapy (group C), decortication following chest tube drainage (group D), video-assisted thoracoscopic surgery (VATS) (group E) and primary operation without chest tube drainage (group F), were applied to the patients. Results: Success rates were 100%, 47.3%, 82.7%, 100%, 100%, and 100% for thoracentesis, chest tube drainage, fibrinolytic treatment, chest tube drainage, decortication following chest tube drainage, VATS and primer operation, respectively. The overall response rate of fibrinolytic therapy was 82.7% (n = 67). Fourteen of 81 (17.2%) patients who went through fibrinolytic instillation did not respond to treatment; these recovered after the application of thoracotomy and VATS. In addition to decortication pulmonary resections were performed in 15 patients. Overall mortality rate was 1.32%. There was no operative mortality. Postoperative morbidity included wound infection in 22, delayed expansion in 17, and atelectasis in 40 patients. Conclusions: Chest tube drainage can be said to be an efficient and safe primary treatment for PPE in children. In cases when chest tube drainage fails to satisfy, decortication with thoracotomy can be applied well with low mortality and morbidity rates.

A Clinical Study of Empyema Thoracis in Children Admitted in Tertiary Care Hospital

A Clinical Study of Empyema Thoracis in Children Admitted in Tertiary Care Hospital

Empyema Thoracis in Children: A 5-Year Experience in a Tertiary Care Institute.

Objective:Empyema thoracis (ET) in children is a disease of significant morbidity and mortality. In the event of failure to resolute following intercostal chest tube drainage (ICD), thoracotomy decortication (TDC) remains the treatment of choice. We have reviewed the outcome of management of 96 cases of ET with the intent to establish the scope of ICD as primary form of the management.Materials and Methods:This is a retrospective study of 96 patients of ET who were managed in pediatric surgery department over a period of 5 years (April 2013 – March 2018). Ninety-six patients at a single center met inclusion criteria for having ET and underwent ICD. We excluded the cases where video-assisted thoracoscopic surgery was provided as primary treatment. The patients were categorized into complicated and uncomplicated groups. Those with pyopneumothorax, encysted empyema, multiloculated empyema, and bilateral ET were assigned as complicated group. There were two treatment groups: (I) those responded with ICD alone (II) those with ICD followed by TDC.Results:All 96 cases received ICD as primary management. There were 54 uncomplicated cases and 42 complicated cases. Out of 42 complicated cases, 26 patients recovered with ICD alone and 16 patients needed TDC. A total of 80 (83.33%) patients (54 uncomplicated ± 26 complicated) recovered with ICD alone. Significant complications were encountered in follow-up of patients who underwent delayed thoracotomy in the form of overriding of the ribs (n = 3) and postoperative air leak (n = 4). There was no mortality in our series.Conclusion:Early initiation of management of ET with intercostal tube drainage is simple, safe, effective even in complicated cases, and has less complications. Thoracotomy with decortication should be reserved for ICD failure cases.

Clinico-Bacteriological Profile and Outcome of Empyema Thoracis in Children below 12 Years of Age

Clinico-Bacteriological Profile and Outcome of Empyema Thoracis in Children below 12 Years of Age

Clinical profile, complications, morbidity and outcome of empyema thoracis in children in a tertiary care centre

Background: Empyema thoracis, an accumulation of pus in pleural space, occurs in 5-10% of children with bacterial pneumonia. Often cases are referred to the tertiary care hospital late resulting in significant complications, morbidity and mortality. Our aim was to study the clinical profile, associated complications, morbidity and treatment outcome of empyema in children.Methods: A prospective observational study was conducted on 65 children aged 0-12 yrs diagnosed with empyema thoracis admitted in the hospital. After history taking and clinical examination, relevant investigations like chest X-ray, USG chest and pleural fluid analysis including culture and sensitivity were done. All patients were treated with chest tube drainage, antibiotics and intrapleural fibrinolytic therapy.Results: Maximum patients (61.5%) were seen in age group 1-5 yrs, 18.4% below 1 year, 2 were neonates. Pleural fluid culture was positive in 64.6 % of patients. Staphylococcus aureus (58.4%) was the most frequent organism isolated from pleural fluid. Pyopneumothorax (36.9%), broncho-pleural fistula (27.6%) and pneumothorax (18.4%) were common complications. Broncho-pleural fistula was present at admission in 14 patients, developed later in 4 patients and healed with conservative management in 12 patients. Majority of the patients (n=51, 78.4%) had complete resolution of empyema thoracis with re-expansion of lung on conservative management alone. The success rate of medical management in patients who received intrapleural fibrinolytic (streptokinase) within 14 days of symptom onset was 93.3% while it was 71.4% in patients who received intrapleural fibrinolytic after 14 days. 5 (7.6%) patients died, 5 required surgical intervention(decortication/VATS), 4 patients with broncho-pleural fistula not improving on conservative management were referred to higher centre and were lost to follow-up.Conclusions: Empyema in children causes significant morbidity which can be reduced by prompt and adequate treatment of bacterial pneumonia. Antibiotics, chest tube drainage along with intrapleural fibrinolytic therapy is a safe and effective method to facilitate drainage and resolution of empyema even in cases with delayed presentation in resource poor settings and can reduce the need for surgery.