Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

Abstract

Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.

Visuomenėje įgytos vaikų pneumonijos komplikacijų diagnostika ir gydymas

“…Įvairių autorių duomenimis, vaikų komplikuotų pneumonijų etiologiją pavyksta nustatyti tik 34-78 proc. atvejų [3,[11][12][13]. Periferinio kraujo mikrobiologiniai pasėliai, serologiniai, bronchų sekreto bei pleuros punktato tyrimai -tai dažniausi tyrimo metodai [3].…”

“…Staphylococcus aureus (meticilinui jautrus, MSSA, meticilinui atsparus, MRSA) -5-9 proc., gramneigiamos bakterijos -5,7 proc., Mycoplasma pneumonia -2-5 proc. Kelių patogenų derinys, ypač virusų ir bakterijų derinys yra svarbus prognozuojant VĮVP eigą ir komplikacijas [12,14].…”

Surveillance of pediatric parapneumonic effusion/empyema in New Zealand

“…Pleural empyema is an uncommon but serious complication of childhood community-acquired pneumonia, 1 resulting in prolonged hospitalization, extended antibiotic therapy, and often requiring invasive intervention. 2 The most common causative organism reported internationally in pediatric empyema is Streptococcus pneumoniae, accounting for 41%-79% of cases [2][3][4][5] with Streptococcus pyogenes and Staphylococcus aureus less frequently recorded. [2][3][4][5] However, New Zealand (NZ) children have a high burden of S. aureus-related disease overall, 6,7 with previous studies identifying S. aureus as a significant cause of complicated pneumonia/parapneumonic effusion/empyema (PPE/E).…”

“…2 The most common causative organism reported internationally in pediatric empyema is Streptococcus pneumoniae, accounting for 41%-79% of cases [2][3][4][5] with Streptococcus pyogenes and Staphylococcus aureus less frequently recorded. [2][3][4][5] However, New Zealand (NZ) children have a high burden of S. aureus-related disease overall, 6,7 with previous studies identifying S. aureus as a significant cause of complicated pneumonia/parapneumonic effusion/empyema (PPE/E). [8][9][10] An increase in childhood empyema incidence has recently been reported in developed nations including Australia, the United States (US), the United Kingdom (UK), and other European countries.…”

Invasive Streptococcus pyogenes infection – a retrospective clinical analysis of 6 cases

“…They are known to cause a broad array of infections of varying severity (1) . Despite great advances in medicine and the possibility to use penicillin, an antibiotic that remains fully active against S. pyogenes, the incidence of infections caused by this pathogen is still high all over the world (2) . S. pyogenes-induced infections are primarily noninvasive, and mostly sporadic.…”