Update on the causes, investigation and management of empyema in childhood

Abstract

Despite being recognised for over two millennia and having an increasing incidence in many countries, the management of childhood empyema remains controversial. This review examines the recent literature on its causes and investigation then focuses on its treatment. Following a trial of appropriate intravenous antibiotics, the evidence would currently support the use of chest drain insertion with urokinase instillation as first line treatment with video-assisted thoracoscopic surgery to be used for failure of medical management. A treatment algorithm is proposed to guide clinical practice.

Survey of hospital procedures for parapneumonic effusion in children highlights need for standardised management

“…In our survey, 99% of the respondents would have ordered blood cultures, in accordance with guidelines . Despite the low yield of this test, which ranges from 10 to 22%, depending on the series, it can contribute to the causal diagnosis .…”

“…Some emphasised the importance of proposing early thoracoscopy to limit the infection‐associated morbidity and to reduce the duration of hospitalisation and discomfort . Others recommended some interventional radiology techniques, equivalent in terms of efficiency but less invasive and less expensive than surgical treatment .…”

Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies

“…In case of SP or S. aureus, additive clindamycin or rifampicin have been mentioned. Duration suggestions range from continuing antibiotics for 5-7 days after resolution of fever till extending the antibiotic course with 2-4 weeks after discharge [76,77].…”

Making the transition from video-assisted thoracoscopic surgery to chest tube with fibrinolytics for empyema in children: Any change in outcomes?

“…De ce nombre, 28 (42 %) ont été traités par CTAV, et 39 (58 %) par DTIF. Aucune différence significative n'a été observée entre ces 2 groupes sur le plan de la durée du séjour (8 A recent survey of pediatric hospitals in the United States demonstrated that the incidence of empyema in children nearly doubled from 3.1 to 6.0 per 100 000 between 1997 and 2009. 1 Changes during this time period also demonstrated increased use of pleural drainage procedures.…”

“…[6][7][8][9] With this technique, children undergo chest tube insertion in the operating room (or in the interventional radiology suite) under general anesthesia (or conscious sedation). These patients then receive intrapleural fibrinolytics administered through the chest tube for 3 days to break down fibrin adhesions and facilitate pleural drainage.…”