Pediatric Parapneumonic Effusion/Pleural Empyema in Japan

Abstract

Background: Pediatric parapneumonic effusion/ pleural empyema (PPE/PE) is a severe infectious condition, and its management should be guided by local epidemiology and the patient's medical history. This survey aimed to determine the clinical and bacteriologic features of PPE/PE in Japan. Methods: A nationwide retrospective questionnaire survey was conducted, targeting 159 pediatric specialist training medical facilities for inpatients ≤18 years of age who were admitted for PPE/PE between January 2007 and December 2016. Results: Valid responses were obtained from 122 facilities, and 96 patients were identified from 38 facilities. The median age (interquartile range) was 2.7 (0.8-7.8) years. Overall, 60 (63 %) patients were men and 49 (51%) had comorbidities. The causative bacteria were identified in 59% of patients by culture except in one case identified using PCR. Streptococcus pyogenes (16%), Staphylococcus aureus (14%) and Streptococcus pneumoniae (13%) were the major pathogens. Carbapenems were administered to 34% of patients without comorbidities. Chest tube drainage was performed in 71%, intrapleural fibrinolytic therapy in 9.4%, surgery in 25% and mechanical ventilation in 29% of the patients. Five patients (5.2%) had complications and one (1.1%) had sequelae, but all patients (100%) survived. Conclusions: This is first report of a nationwide survey pertaining to pediatric PPE/PE in Japan. We found that the etiology showed a different trend from that reported in other countries. It is worrisome that molecular methods were rarely used for pathogenic diagnosis and carbapenems were overused. Thus, it is imperative to establish clinical guidelines for PPE/PE in Japan.

Evaluation of the efficiency of the systemic immune‐inflammation index in differentiating parapneumonic effusion from empyema

“…While PPEs can usually be treated with antibiotics without chest tube drainage; in case of empyema, a chest tube should be inserted and pus drained and intrapleural fibrinolytic therapy should be used if necessary. 4,6,8,13 Imaging methods and laboratory findings can be used to differentiate empyema from PPE. In an adult study conducted from Turkey in the empyema group, WBC, CRP, ALC, and LMR were found to be significantly higher than PPE group and LMR was more sensitive than other markers.…”

“…Although the rates of pathogens causing PPE/empyema have changed with the spread of Streptococcus pneumoniae and Haemophilus influenzae type b vaccine in recent years, the most frequently detected bacterial pathogens are still S. pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. [5][6][7] Rapid differentiation of PPE and empyema in pediatric emergency departments (PED) is important in terms of managing patients and providing timely treatment, predicting prognosis and avoiding unnecessary invasive procedures. Imaging methods, acute phase reactants, and pleural fluid sampling are helpful in distinguishing PPE/ empyema.…”

“…Approximately 2%–12% of children with pneumonia and 28% of hospitalized patients with pneumonia can develop these undesirable outcomes. Although the rates of pathogens causing PPE/empyema have changed with the spread of Streptococcus pneumoniae and Haemophilus influenzae type b vaccine in recent years, the most frequently detected bacterial pathogens are still S. pneumoniae , Streptococcus pyogenes , and Staphylococcus aureus 5–7 …”

Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan 2022

“…In a nationwide retrospective study of hospital cases of pediatric empyema over a 10-year period in Japan, the 3 major pathogens were Group A streptococci, S. pneumoniae and S. aureus 32 (Table 8).…”

Elevated Nitrite/Nitrate Ratio as a Potential Biomarker for the Differential Diagnosis of Pleural Effusions

“…Several studies have reported that the most common bacterial causes of parapneumonic effusion or empyema include the Streptococcus milleri group, Streptococcus pneumoniae, and Staphylococcus aureus [ 21 ]. Many infectious microorganisms can reduce nitrate to nitrite [ 22 , 23 , 24 ], which further inspired us to hypothesize whether the nitrite concentration and/or nitrite/nitrate ratio in PEs could help with the IPE diagnosis.…”