Pneumococcal Pleural Empyemas in Children

Abstract

Empyema rarely complicates pneumonia. In a 361-bed regional pediatric hospital, 50 pleural empyemas were identified from 1988 through 1994; 17 (34%) occurred in the last 12 months of this period, for which the incidence was 3.3 per 100,000 of the population aged < or = 18 years (P < .05, chi 2 test). A significant seasonal prevalence was observed: 50% of cases occurred in the winter (P < .001, chi 2 test). In contrast with the findings of previous studies, in which empyemas predominantly occurred in infants, the median age of our patients was 7 years; underlying illnesses were present in only 10%, and all had community-acquired disease. Eighty-two percent had chest tubes inserted, 56% required a thoracotomy with pleural decortication, and 2% had a lobectomy. There were no deaths. Streptococcus pneumoniae was isolated in 40% of the cases; specimens in 44% of the cases were sterile. None of the empyemas were associated with Staphylococcus aureus or Haemophilus influenzae type b, and only one was caused by group A streptococcus. Among 13 S. pneumoniae isolates, the rate of resistance to penicillin was 15%; to erythromycin, 15%; to chloramphenicol, 31%; and to cefotaxime, 23%. The penicillin-resistance rate among blood and cerebrospinal fluid pneumococcal isolates was 17% during 1993-1994. Drug-resistant S. pneumoniae is now a recognized cause of pleural empyemas in children.

Distribution of Streptococcus pneumoniae Serotypes That Cause Parapneumonic Empyema in Turkey

“…Empyema, as a complication of pneumonia, was defined according to several major and minor criteria (21). The major criteria were the presence of pus in the pleural space, the need for surgical decortication, and the positivity of a pleural fluid culture.…”

Clonality of Streptococcus pneumoniae Serotype 1 Isolates from Pediatric Patients in the United States

“…Streptococcus pneumoniae serotype 1 is not a commonly recovered pneumococcal serotype among children with invasive or local respiratory disease in the United States and is not included in the 7-valent pneumococcal conjugate vaccine (6,7). Several investigators have documented an increase in invasive disease caused by S. pneumoniae capsular serotype 1 in selected populations in North America (3,5,14).…”

The Role of Pleural Biopsy in the Diagnosis of Empyema Thoracis With Special Reference to the Tuberculosis

“…5 et al (51.81%), William et al 6 pyogenic (40%). Our study has shown TB as the most common origin, i.e.…”