Impact of fibrinolytics on the outcome of empyema in South African children

Zampoli, Marco; Kappos, Alexia; Verwey, Charl; Mamathuba, Rendani; Zar, Heather J.

doi:10.7196/samjnew.7796

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…This is in contrast to high-income settings, where the use of fibrinolytics is recommended with intercostal drainage, as the outcome is similar to that of VATS. [7,8,15] Furthermore, use of fibrinolytic therapy in low-resource settings may have additional value because the shortage of surgeons and postoperative intensive care facilities delays surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Empyema in children hospitalised at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: A retrospective study

et al. 2018

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The incidence of empyema has reportedly increased in some highincome countries since the introduction of childhood seven-valent pneumococcal conjugate vaccine (PCV), [1-4] although there is a paucity of such data from low-and middle-income settings. Recent studies from South Africa (SA) and the USA suggested a decrease in the incidence of empyema since the introduction of 13-valent PCV. [5,6] Nonetheless, Streptococcus pneumoniae (serotypes 1, 3 and 19A) remains the commonest (10-48%) pathogen identified, followed by Staphylococcus aureus (8-19%), and less commonly Haemophilus influenzae and Mycoplasma pneumoniae. [3,5] In tuberculosis (TB)endemic settings, Mycobacterium tuberculosis (MTB) may account for 10-14% of cases. [5] However, studies in high-income countries indicate that in most instances the aetiology of the empyema may be unknown, as <30% of blood, pleural fluid or sputum cultures yield an organism. [3] The use of molecular techniques has been shown to improve diagnostic yield. [4] The management of empyema remains challenging, even in highincome countries. [3] Antibiotics alone have been recommended in children with no respiratory compromise, and fibrinolytics are recommended with either pigtail or intercostal drain (ICD) insertion in patients with respiratory compromise or failure to respond to antibiotics. Early video-assisted thorascopic surgery (VATS) for drainage, used as first-line treatment, has not been shown to improve outcomes at 6 months compared with use of an ICD and fibrinolytics. [7,8] The use of fibrinolytics may reduce the need for more invasive and expensive surgical options. Objectives To describe the clinical epidemiology of empyema at a secondarytertiary hospital with a paediatric pulmonology referral service, in a setting of high HIV and TB prevalence. Methods A retrospective descriptive study was undertaken in children aged <14 years at Chris Hani Baragwanath Academic Hospital (CHBAH) over the 5-year period January 2012-December 2016. CHBAH is a secondary-tertiary academic hospital situated in Soweto, a periurban and mostly low-income township south of Johannesburg, SA. In addition to providing a paediatric service to the residents of Soweto, this hospital is the referral centre for hospitals in the surrounding areas. The prevalence of childhood HIV infection is 3-4%, while 30% of newborns are HIV-exposed in this setting. [9] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Section: Discussionmentioning

confidence: 99%

Empyema in children hospitalised at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: A retrospective study

et al. 2018

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“…Para pneumonic effusion and empyema most frequently occur as a complication of bacterial pneumonia. 16 Due to the delay in seeking medical opinion and indiscriminate use of antibiotics, it is very difficult to isolate microorganisms in the Indian set up. In the present study 105 children with empyema were evaluated over 24 months for the clinical course of the disease, bacteriological profile, and various treatment options.…”

Section: Discussionmentioning

confidence: 99%

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

Dhal

Champatiray

et al. 2023

Asian J Med Sci

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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.

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“…There is great variation world wide in the management of patients with pleural infection, and approaches differ between physicians especially in developing countries due to the absence of facilities. [15][16][17] Since the mid 1990s, management strategies using fibrinolytics (introduced first in 1949) and thoracoscopic surgery have evolved. Although the British Thoracic Society published national guidelines in 2005 for the management of pleural infection in children, the treatment of choice remains a matter of controversy in the literature and in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Pediatric pleural empyema: one of the management challenges in children of Democratic Republic of Congo

et al. 2017

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Empyema is a serious complication characterized by purulent exudate and bacteria in the pleural space, which may progress to necrosis, cavitations or fistulas in the thoracic cavity. It remains a major challenge throughout low-income countries. Objectives were to emphasize the role of basic medical and radiologic approach and to resolve a severe lung complication when facilities are inadequate. A five-year-old female was referred with distress respiratory to the Emergency Unit of Monkole, a large public-private missionary hospital in Kinshasa, Congo. Chest X-ray showed a massive empyema that was resolved by immediate drainage and antibiotiocs. Results were rapid improvement and discharge after 3 weeks. A classic medical and imaging approach is a winning return in low-income countries. According to the British Thoracic Society guidelines, pleural effusion with compromising respiratory function can be managed by drainage and antibiotics.

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Impact of fibrinolytics on the outcome of empyema in South African children

Cited by 6 publications

References 18 publications

Empyema in children hospitalised at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: A retrospective study

Empyema in children hospitalised at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: A retrospective study

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

Pediatric pleural empyema: one of the management challenges in children of Democratic Republic of Congo

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