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Alemayheu G, Lee CSJ, Erdman LK, Wong J, Rutherford C, Smieja M, Khan S, Pernica JM. Children hospitalized with community-acquired pneumonia complicated by effusion: a single-centre retrospective cohort study. BMC Pediatr 2023; 23:181. [PMID: 37072740 PMCID: PMC10113124 DOI: 10.1186/s12887-023-04004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVES To describe children hospitalized with community-acquired pneumonia complicated by effusion (cCAP). DESIGN Retrospective cohort study. SETTING A Canadian children's hospital. PARTICIPANTS Children without significant medical comorbidities aged < 18 years admitted from January 2015-December 2019 to either the Paediatric Medicine or Paediatric General Surgery services with any pneumonia discharge code who were documented to have an effusion/empyaema using ultrasound. OUTCOME MEASURES Length of stay; admission to the paediatric intensive care unit; microbiologic diagnosis; antibiotic use. RESULTS There were 109 children without significant medical comorbidities hospitalized for confirmed cCAP during the study period. Their median length of stay was 9 days (Q1-Q3 6-11 days) and 35/109 (32%) were admitted to the paediatric intensive care unit. Most (89/109, 74%) underwent procedural drainage. Length of stay was not associated with effusion size but was associated with time to drainage (0.60 days longer stay per day delay in drainage, 95%CI 0.19-1.0 days). Microbiologic diagnosis was more often made via molecular testing of pleural fluids (43/59, 73%) than via blood culture (12/109, 11%); the main aetiologic pathogens were S. pneumoniae (40/109, 37%), S. pyogenes (15/109, 14%), and S. aureus (7/109, 6%). Discharge on a narrow spectrum antibiotic (i.e. amoxicillin) was much more common when the cCAP pathogen was identified as compared to when it was not (68% vs. 24%, p < 0.001). CONCLUSIONS Children with cCAP were commonly hospitalized for prolonged periods. Prompt procedural drainage was associated with shorter hospital stays. Pleural fluid testing often facilitated microbiologic diagnosis, which itself was associated with more appropriate antibiotic therapy.
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Affiliation(s)
| | - Claire S J Lee
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura K Erdman
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Jacqueline Wong
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Candy Rutherford
- Hamilton Regional Laboratory Medicine Program, Hamilton, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Sarah Khan
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1280 Main St West, L8S 4K1, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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Moral L, Toral T, Marco N, Clavijo A, Canals F, Forniés MJ, González MC, Moral J, Márquez M, Lucas R, Caballero M, Huertas AM, García-Avilés B, Belda M. Epidemiology of pediatric parapneumonic pleural effusion during 13-valent pneumococcal conjugate vaccine implementation. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00175-7. [PMID: 35985928 DOI: 10.1016/j.eimce.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The reported incidence of parapneumonic pleural effusion, including empyema, has shown fluctuations in the last decades. It has been related to the implementation of different types of conjugate pneumococcal vaccines. METHODS We have retrospectively reviewed data from all 10 public hospitals in Alicante Province (Spain) covering a population of 279,000 children under 15 years of age, between 2010 and 2018. Effusions less than 10 mm (PE-) and those of 10 mm or more (PE+) were separated. RESULTS A total of 366 episodes of parapneumonic pleural effusion have been analyzed, 178 PE- (48.6%) and 188 PE+ (51.4%), with a median age of 4 years (interquartile range: 2-7 years) and marked seasonality with the maximum in winter and the minimum in summer. A culture proven bacterial agent was identified in 34 patients (9.3%), mainly Streptococcus pneumoniae (24 patients) followed by Streptococcus pyogenes (7 patients). The most frequent S. pneumoniae serotype was 19A (6 patients) and 3 vaccine failures were observed. The mean annual incidence rate was 14.3 cases per 100,000 children under 15 years of age (7.0 for PE- and 7.3 for PE+). No significant changes were observed in incidence over time, but noticeable differences in incidence were observed in different health departments. CONCLUSIONS We have not found temporal variations in incidence of parapneumonic effusion despite the implementation of the 13-valent pneumococcal conjugate vaccine. The unexplained disparity in incidence between close departments is noteworthy.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Teresa Toral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Nuria Marco
- Servicio de Pediatría, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Agustín Clavijo
- Servicio de Pediatría, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Francisco Canals
- Servicio de Pediatría, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María José Forniés
- Servicio de Pediatría, Hospital Universitario Virgen de la Salud, Elda, Alicante, Spain
| | | | - Jorge Moral
- Facultad de Medicina, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
| | - Marta Márquez
- Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raquel Lucas
- Servicio de Pediatría, Hospital Marina Salud, Denia, Alicante, Spain
| | - María Caballero
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Ana María Huertas
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Belén García-Avilés
- Servicio de Pediatría, Hospital Clínico Universitario de Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Mónica Belda
- Servicio de Pediatría, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
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Epidemiología del derrame pleural paraneumónico en la infancia durante la implementación de la vacuna antineumocócica conjugada de 13 serotipos. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yang L, Zhu Y, Wu G. Intrapleural injection of urokinase in the treatment of acute Haemophilus influenza empyema in children: A case report and literature review. Front Pediatr 2022; 10:882005. [PMID: 35935372 PMCID: PMC9352951 DOI: 10.3389/fped.2022.882005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study is to analyze the clinical data of a child with acute empyema caused by Haemophilus influenzae, and to investigate the diagnosis and treatment of this disease through literature review to improve the clinical understanding of this kind of disease. METHODS A 6-year-old female with acute H. influenzae empyema was treated at the Department of Pediatrics of The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China. The pleural puncture fluid turned out to be yellow turbid pus, and the pleural effusion was diagnosed as empyema according to the classification of pleural effusions. High-throughput sequencing revealed the presence of H. influenzae. After comprehensive treatment, including antibiotics, closed pleural drainage, and intrapleural injection of urokinase, the pleural effusion was absorbed and discharged. A systematic literature search in Pubmed, Embase, Scopus, CNKI, Wanfang, and VIP Chinese databases revealed no cases of acute empyema in children caused by H. influenza and treated with urokinase. RESULTS There was no bronchopleural fistula and tension pneumothorax during the treatment. One month after discharge, chest computed tomography (CT) revealed no pleural thickening and normal pulmonary function. CONCLUSION Pneumonia in the child worsened after an initial improvement of symptoms, which is an issue that requires further medical attention. High-throughput sequencing of pathogens in pleural effusion can improve the detection rate. This study indicated that closed pleural drainage combined with intrapleural injection of urokinase is an effective treatment for H. influenzae empyema in children.
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Affiliation(s)
- Lin Yang
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - YaFei Zhu
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - GuangSheng Wu
- Department of Pediatrics, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Nakagawa Y, Otake S, Oue T, Ryu H, Kasai M. Case of infant invasive Streptococcus intermedius infection suggesting the need for anaerobic cultures. J Infect Chemother 2021; 28:437-439. [PMID: 34794869 DOI: 10.1016/j.jiac.2021.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/08/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
We report the case of an immunocompetent 6-month-old boy with a lung abscess and empyema caused by Streptococcus intermedius detected only from anaerobic cultures. Invasive S. intermedius infection in infants is rare. S. intermedius has been infrequently reported as a causative microorganism of lung abscess and empyema as most of the S. intermedius infections in children have been head and neck infections. While anaerobic cultures are often not performed for infant patients, we suggest the need for these cultures, including blood cultures, especially in cases of pediatric empyema, brain abscess, and liver abscess, which can be caused by S. intermedius.
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Affiliation(s)
- Yui Nakagawa
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Shogo Otake
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Japan.
| | - Tomoko Oue
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Hayato Ryu
- Department of Clinical Laboratory, Hyogo Prefectural Kobe Children's Hospital, Japan
| | - Masashi Kasai
- Division of Infectious Disease, Department of Pediatrics, Hyogo Prefectural Kobe Children's Hospital, Japan
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