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Jacobson J, Fabri L, Osowicki J, Shanthikumar S, Costa AM, Ortika B, Wee-Hee A, Pragassen M, Gatt C, Gonis G, Nguyen C, Rozen T, Teague W, Buttery J, Clifford V, Mulholland K, Steer A, Ranganathan S, Daley A, Dunne E, Satzke C. Evaluation of a multiplex-qPCR for paediatric pleural empyema-An observational study in hospitalised children. PLoS One 2024; 19:e0304861. [PMID: 38917227 PMCID: PMC11198775 DOI: 10.1371/journal.pone.0304861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Pleural empyema is a serious complication of pneumonia in children. Negative bacterial cultures commonly impede optimal antibiotic therapy. To improve bacterial identification, we developed a molecular assay and evaluated its performance compared with bacterial culture. Our multiplex-quantitative PCR to detect Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus and Haemophilus influenzae was assessed using bacterial genomic DNA and laboratory-prepared samples (n = 267). To evaluate clinical performance, we conducted the Molecular Assessment of Thoracic Empyema (MATE) observational study, enrolling children hospitalised with empyema. Pleural fluids were tested by bacterial culture and multiplex-qPCR, and performance determined using a study gold standard. We determined clinical sensitivity and time-to-organism-identification to assess the potential of the multiplex-qPCR to reduce the duration of empiric untargeted antibiotic therapy. Using spiked samples, the multiplex-qPCR demonstrated 213/215 (99.1%) sensitivity and 52/52 (100%) specificity for all organisms. During May 2019-March 2023, 100 children were enrolled in the MATE study; median age was 3.9 years (IQR 2-5.6). A bacterial pathogen was identified in 90/100 (90%) specimens by multiplex-qPCR, and 24/100 (24%) by bacterial culture (P <0.001). Multiplex-qPCR identified a bacterial cause in 68/76 (90%) culture-negative specimens. S. pneumoniae was the most common pathogen, identified in 67/100 (67%) specimens. We estimate our multiplex-qPCR would have reduced the duration of untargeted antibiotic therapy in 61% of cases by a median 20 days (IQR 17.5-23, range 1-55). Multiplex-qPCR significantly increased pathogen detection compared with culture and may allow for reducing the duration of untargeted antibiotic therapy.
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Affiliation(s)
- Jonathan Jacobson
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Loraine Fabri
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Joshua Osowicki
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Anna-Maria Costa
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Belinda Ortika
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Ashleigh Wee-Hee
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Michelle Pragassen
- Complex Care Hub, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Cassandra Gatt
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Gena Gonis
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Cattram Nguyen
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical and Epidemiology Biostatistics Unit, Murdoch Children’s Research Institute and The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Thomas Rozen
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Warwick Teague
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Surgery, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Surgical Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jim Buttery
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
- Infection and Immunity, Monash Children’s Hospital, Clayton, Victoria, Australia
- Department of Paediatrics & Monash Centre for Health Care Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Vanessa Clifford
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Kim Mulholland
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Andrew Steer
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital Parkville, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Andrew Daley
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Microbiology, The Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Eileen Dunne
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Satzke
- Infection, Immunity and Global Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
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Forster J, Paul P, Liese J. Current Management of Pediatric Parapneumonic Pleural Effusions and Pleural Empyema. Pediatr Infect Dis J 2023; 42:e407-e410. [PMID: 37566896 DOI: 10.1097/inf.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Affiliation(s)
- Johannes Forster
- From the Institute for Hygiene and Microbiology, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Pia Paul
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Liese
- Department of Pediatrics, University Hospital Würzburg, Würzburg, Germany
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Papachristidou S, Lapea V, Charisi M, Kourkouni E, Kousi D, Xirogianni A, Dedousi O, Papaconstadopoulos I, Eleftheriou E, Krepis P, Pasparaki S, Pantalos G, Doudoulakakis A, Bozavoutoglou E, Daskalaki M, Kostaridou-Nikolopoulou S, Tzanakaki G, Spoulou V, Tsolia M. A multicenter study on the epidemiology of complicated parapneumonic effusion in the era of currently available pneumococcal conjugate vaccines. Vaccine 2023; 41:6727-6733. [PMID: 37805358 DOI: 10.1016/j.vaccine.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Parapneumonic effusion (PPE) is a common complication of pneumonia. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. A reduction in pneumonia hospitalizations has been observed since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Despite this apparent benefit, an increase in the incidence of PPE was recorded in some countries following PCV7 implementation. As the 13-valent pneumococcal conjugate vaccine (PCV13) was expected to provide a wider protection against PPE, the aim of the present study was to evaluate the impact of PCV13 introduction on the epidemiology of complicated parapneumonic effusion (c-PPE) among children in the Athens greater area. METHODS All cases of community-acquired pneumonia (CAP) with PPE requiring chest tube insertion (complicated PPE, c-PPE) hospitalized in the 3 public Children's hospitals in Athens between 01/01/2004 and 31/12/2019 were included in the study. RESULTS A total of 426 cases of c-PPE associated with pneumonia were recorded of which 198 were admitted during 2004-2010 (period A, prePCV13/PCV -7 introduction period) and 228 during 2011-2018 (period B, post - PCV13 period). A definite bacterial etiology was established in 44.4 % of all cases and of those 25.4 % were caused by S. pneumoniae. An increasing trend in c-PPE incidence was observed during period A; although, a significant decrease on c-PPE annual rates was observed during the period B (p = 0.011), a remarkable increase in serotype 3 cases was recorded. CONCLUSION A decreasing time trend in c-PPE cases among children was shown after the introduction of PCV13 in our area. However, serotype 3 is nowadays a common cause of PPE. Hence, continuous surveillance is imperative in order to follow c-PPE epidemiology over time.
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Affiliation(s)
- Smaragda Papachristidou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece.
| | - Vasiliki Lapea
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Martha Charisi
- Department of Paediatrics, Penteli Children's Hospital, Athens, Greece
| | - Eleni Kourkouni
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Dimitra Kousi
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Athanasia Xirogianni
- National Meningitis Reference Laboratory, Dept of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Olga Dedousi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Irene Papaconstadopoulos
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Eirini Eleftheriou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Panagiotis Krepis
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Sophia Pasparaki
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Georgios Pantalos
- Pediatric Intensive Care Unit, Penteli's Children Hospital, Penteli, Greece
| | | | | | - Maria Daskalaki
- Microbiology Laboratory, Penteli Children's Hospital, Athens, Greece
| | | | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Dept of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Vana Spoulou
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Tsolia
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
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Baldes N, Bölükbas S. Entzündliche und infektiöse Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen. Zentralbl Chir 2022; 147:287-298. [DOI: 10.1055/a-1720-2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungEntzündliche Erkrankungen der Lunge und Pleura bei Kindern und Jugendlichen umfassen ein weites Spektrum von der komplizierten Pneumonie, der Tuberkulose, Mykosen bis hin zur Echinokokkose.
Die Häufigkeit hängt stark von der geografischen Herkunft ab. Diese Übersichtsarbeit gibt einen Überblick von der Diagnostik bis hin zur chirurgischen Therapie dieser Erkrankungen beim
pädiatrischen Kollektiv.
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Affiliation(s)
- Natalie Baldes
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
| | - Servet Bölükbas
- Klinik für Thoraxchirurgie, KEM Kliniken Essen-Mitte, Essen, Deutschland
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Fotsch DM, Fox J, Snedden TR. Unexpected Pneumonia Diagnosis From Pediatric Abdominal Pain: A Case Report. J Pediatr Health Care 2022; 36:170-173. [PMID: 34961629 DOI: 10.1016/j.pedhc.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Abdominal pain in the context of fever, tachypnea, or cough is a known presentation of pneumonia in preschool-aged children. We describe a 4-year-old male who presented to a pediatric emergency department with abdominal pain and decreased appetite. During his abdominal pain workup, he was found to have pneumonia complicated by pleural effusion and pneumothorax. It is critical for pediatric providers to be aware of age-based differentials.
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Thimmesch M, Mulder A, Lebrun F, Piérart F, Genin C, Loeckx I, Demaret P. Management of parapneumonic pleural effusion in children: Is there a role for corticosteroids when conventional nonsurgical management fails? A single-center 15-year experience. Pediatr Pulmonol 2022; 57:245-252. [PMID: 34559458 DOI: 10.1002/ppul.25699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Description of the use of corticosteroids for the management of parapneumonic pleural effusion in children. METHODS Retrospective single-center observational study of all children hospitalized with a diagnosis of parapneumonic pleural effusion during a 15-year period. RESULTS We documented 97 cases of parapneumonic effusion during the study period, with a median age (interquartile range [IQR]) of 43 (33-61) months. Most of the children benefited from an evacuation of the pleural effusion (89/97, 91.8%): 21 patients (21.6%) were treated with needle thoracocentesis only, while a chest tube was inserted in 68 children (70.1%). Thirty-two patients (33%) were treated with intrapleural fibrinolysis. Fifty-five children (56.7%) received corticosteroids for persistent fever. The median time (IQR) between hospital admission and initiation of corticosteroids was 5.5 (4-7) days. When corticosteroids were initiated, children had been febrile for 9 (IQR: 8-11) days. The fever ceased in a median (IQR) of 0 (0-1) day after corticosteroids initiation. Only one patient required a video-assisted thoracoscopy that was necessary for morphological reasons (morbid obesity). No children treated with corticosteroids required surgery. All children were discharged from hospital. The median (IQR) hospital length of stay was 11 (8-14) days, with no difference between children with and those without corticosteroids. CONCLUSION Our findings indicate that corticosteroids may be a part of the therapeutic armamentarium for children with parapneumonic effusion when conventional nonsurgical management fails.
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Affiliation(s)
- Matthieu Thimmesch
- Division of Pediatric Pulmonology, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - André Mulder
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - Frédéric Lebrun
- Division of Pediatric Pulmonology, Department of Pediatrics, CHC MontLégia, Liège, Belgium.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - Frédéric Piérart
- Division of Pediatric Pulmonology, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - Caroline Genin
- Division of Pediatric Infectiology, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - Isabelle Loeckx
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC MontLégia, Liège, Belgium
| | - Pierre Demaret
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC MontLégia, Liège, Belgium
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7
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Ibarra Rodriguez M, Garrido Pérez J, Rueda F, Murcia Pascual F, Wiesner Torres S, Paredes Esteban R. Fibrinolysis versus thoracoscopy: Comparison of results in empyema management in the child. Ann Thorac Med 2022; 17:145-150. [PMID: 35968395 PMCID: PMC9374122 DOI: 10.4103/atm.atm_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: The objective of this study is to compare the outcome of treatment with drainage and urokinase (UK) versus thoracoscopy (TS) in pleural empyema secondary to complicated pneumonia. METHODS: This was a retrospective study of patients with complicated parapneumonic effusions between 2008 and 2019 treated with UK or TS. Epidemiological and evolutionary data compared days of fever, antibiotic, pre- and postprocedure stay, time to radiological resolution, and complications. The results were expressed as medians and the comparisons were made by the Mann–Whitney U-test. RESULTS: Of 143 patients with NC, 46 were empyemas (26 men), 25 were treated with TS, and 10 were treated with UK. The remaining 11 received combined treatment, being excluded from the study. There were no significant differences between TS versus UK in age (median 4 vs. 3 years), days of fever before the procedure (4 vs. 2) and after (2 vs. 2), days of antibiotic treatment before the procedure (4 vs. 4), overall hospital stay (15 vs. 13 days), and months until radiological normalization (2 vs. 2). The complications related to the therapy were scarce in both groups and had no impact on evolution. Patients with TS had a longer preprocedural stay (4 vs. 1; P < 0.001) and required fewer days of subsequent antibiotic after procedure (8 vs. 11; P = 0.03), and a shorter overall antibiotic treatment time (11 vs. 16; P = 0.03). They also had a shorter post-TS stay (9 vs. 12 days), although this difference did not become significant (P = 0.09). CONCLUSIONS: In our experience, the results obtained with both procedures are quite similar, although patients undergoing TS had a better evolution (fewer days of antibiotic and a tendency to less hospitalization), despite having been performed a priori in more evolved patients.
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Yang G, Wen Y, Chen T, Xu C, Yuan M, Li Y. Comparison of pediatric empyema secondary to tuberculosis or non-tuberculosis community-acquired pneumonia in those who underwent surgery in high TB burden areas. Pediatr Pulmonol 2021; 56:3321-3331. [PMID: 34289260 DOI: 10.1002/ppul.25591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tuberculous empyema (TE) in children is common in high-TB burden and medical resource-limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. METHODS We performed a retrospective study of children with empyema secondary to community-acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non-tuberculosis infection (non-tuberculosis empyema, NTE). RESULTS One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest-tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. CONCLUSION Tuberculosis infection should be screened in management of children with empyema in high-TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource-limited area.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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9
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Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
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Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
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10
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Kanitra JJ, Thampy CA, Cullen ML. A decade's experience of pediatric lung abscess and empyema at a community hospital. Pediatr Pulmonol 2021; 56:1245-1251. [PMID: 33386780 DOI: 10.1002/ppul.25254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Discussions on the diagnostic and management of acquired pediatric lung pathology are usually published by large tertiary children's hospitals. It is likely that much of this pathology is actually seen and managed in nonacademic practices. METHODS A 10-year retrospective review of patients under 18-years of age, treated for lung abscesses or empyema was performed. RESULTS Nineteen empyema and four lung abscesses were included. Presenting symptoms, workup, and management are reviewed. A unique subset (n = 4) of atypical pulmonary pathology is described. A 14-year-old with a vaping history and a lung abscess misdiagnosed as an empyema. A 15-year-old with primary pulmonary Hodgkin's lymphoma presenting as a lung abscess and empyema. A 5-year-old with an empyema complicated by a bronchopleural fistula and a 21-year-old with autism and an acquired lung cyst. CONCLUSION Our dilemmas, experiences, and strategies in managing complex lung disease are generalized to community-based practice.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Chelsea A Thampy
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Marc L Cullen
- Division of Pediatric Surgery, Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
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Oyetunji TA, Dorman RM, Svetanoff WJ, Depala K, Jain S, Dekonenko C, St Peter SD. Declining frequency of thoracoscopic decortication for empyema - redefining failure after fibrinolysis. J Pediatr Surg 2020; 55:2352-2355. [PMID: 31983399 DOI: 10.1016/j.jpedsurg.2019.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary fibrinolysis for pediatric empyema has become standard of care at our institution. Early study of our protocol revealed a 16% thoracoscopic decortication rate after primary fibrinolysis. We now report the frequency with which children progress to operation with maturation of the protocol. METHODS A database of patients diagnosed with empyema between September 2014 and March 2019 was examined. Patients who underwent tissue plasminogen activator (tPA) therapy with or without subsequent video-assisted thoracoscopic (VATS) decortication were included. Patients with additional indications for tube thoracostomy or VATS were excluded. RESULTS Forty-eight patients were included. Median age was 4.5 years [IQR 2-9.3]. Median length of stay (LOS) was 8 days [IQR 6-11]. No patients underwent primary VATS. Median days with a chest tube was 5 [IQR 5-6] and median number of doses of tPA was 3 [IQR 3-3]. Seven patients (14.6%) had a chest tube replaced without undergoing VATS. The VATS rate was 4.2% in the first half of this study but 0% in the last 33 months. CONCLUSION Thoracoscopic decortication is rarely necessary in children with empyema. Raising the threshold for surgical intervention and utilizing further nonoperative measures can avoid an operation in most children without increasing in-hospital length of stay. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tolulope A Oyetunji
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
| | - Robert M Dorman
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Kartik Depala
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
| | - Shubhika Jain
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA
| | - Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108, USA.
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Thoracoscopic debridement for empyema thoracis. J Pediatr Surg 2020; 55:2187-2190. [PMID: 32147236 DOI: 10.1016/j.jpedsurg.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/27/2019] [Accepted: 02/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND/PURPOSE The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN). METHODS Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap. RESULTS 106 patients with a median age of 4 years (IQR 2-6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)). CONCLUSIONS Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia. LEVEL OF EVIDENCE Level IV.
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Pogorelić Z, Bjelanović D, Gudelj R, Jukić M, Petrić J, Furlan D. Video-Assisted Thoracic Surgery in Early Stage of Pediatric Pleural Empyema Improves Outcome. Thorac Cardiovasc Surg 2020; 69:475-480. [PMID: 32268399 DOI: 10.1055/s-0040-1708475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study was to observe outcomes of early decortication in a treatment of pleural empyema using video-assisted thoracoscopic surgery (VATS). METHODS The case records of 21 pediatric patients who underwent VATS for empyema between 2009 and 2019 were retrospectively reviewed. Patients were observed based on demographic, laboratory, and clinical data, as well as treatment outcomes. RESULTS Out of a total of 59 patients treated for pleural empyema, 21 (10 male and 11 female) children with a median age of 5 years (interquartile range [IQR] 2.8; 6.0) received VATS. The empyema was classified as stage I in 2 patients (9.5%), stage II in 4 patients (19%), and stage III in 15 patients (71.5%). Median surgical time was 60 minutes (IQR 50; 90). There were 2 (9.5%) postoperative complications and 1 recurrence (4.8%). Children treated in stages I and II showed significantly better postoperative results compared with the children treated in stage III. Length of hospital stay (8 vs. 10 days; p = 0.01), length of intensive care unit stay (1 vs. 5 days; p < 0.001), duration of chest tube drainage (4 vs. 6 days; p = 0.043), duration of postoperative fever (1.5 vs. 4 days; p = 0.001), and surgical time (40 vs. 70 minutes; p < 0.001) were significantly shorter in children operated in stages I and II than in stage III. CONCLUSION Early decortication using a VATS is a successful, effective, and easily performed surgical method in the treatment of pediatric pleural empyema, as well as a method that significantly improves recovery time and shortens the hospital stay.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | | | - Ružica Gudelj
- Faculty of Medicine, University of Split, Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Jasna Petrić
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | - Dubravko Furlan
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
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Intrapleural Fibrinolytic Therapy in Empyema Thoracis: Where are we now and where do we go from here? Indian J Pediatr 2019; 86:1081-1082. [PMID: 31713216 DOI: 10.1007/s12098-019-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
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