Journal Article

8455 Retrospective observational review of management of empyema thoracis in a tertiary paediatric centre

Gowai, Hani, Ibuola, Oluwanifemi

2025

Overview

Why did you do this work?Empyema thoracis is a recognised complication of pneumonia. While there are guidelines by the British Thoracic Society (BTS) for the management of pleural infection in children, there is still a varied approach to practice across centres.What did you do?This study is a service evaluation audit detailing patients with empyema and care received at our centre.We reviewed the medical records of admissions with empyema over a period of 16 months (January 2023 – May 2024). We have excluded uncomplicated pleural effusions in this study. We aimed to outline the demographic, compare reproducibility of clinical management and identify aggravating factors. Data was analysed using Microsoft Excel.What did you find?A total of 9 children were admitted for empyema in the period with male:female was (3:6), and more ≤5-year-old (6:3). All were healthy children with immunisation history confirmed in 6 of the children as up to date.All blood cultures had no growth. Pleural fluid culture was positive for only 2 cases (Streptococcus pneumoniae, Streptococcus milleri). Pleural fluid PCR yielded 4 Streptococcus pneumoniae, 1 Streptococcus pyogenes, 2 negative PCRs and 2 unrequested.There were 4 negative throat swabs, positive swabs had mixed growth with Rhinovirus (3), RSV, Streptococcus A, Mycoplasma (2), COVID and Human Metapneumovirus (HMPV) (1) with associated prolonged defervescence (7.8 vs 6).All had a chest ultrasound, and a chest drain placement at averagely 2 days post admission (1–6) with post placement X-rays and mean drain duration 4.2 days (1–7). Only 2 children required a Video Assisted Thoracoscopy surgery (VATS). 5 children completed 6 doses of Urokinase therapy. Asides discomfort while in-situ, there were no documented complications of the drain.Initial antibiotic therapy was varied with Co-Amoxiclav, Cefuroxime, Cefotaxime and Amoxicillin used initially. Clindamycin was added in all. Further changes were microbiology guided. Intravenous medication administration averaged 12.8 days (7–18), and fever defervescence from admission was average of 7 days (2–16).Oral antibiotic at discharge was for an average period of 24.9 days (14–28) with Co-Amoxiclav: Amoxicillin (6:3). Average discharge CRP was 34.7 (7–72) versus 284.8 at admission (92–510). The average in-hospital stay was 13 days (8–17).Vaccine response was requested for only 3 of the 9 children.All children were scheduled for respiratory clinic follow up within 8–12 weeks.What does it mean?The striking finding is the varied choice of IV antibiotics. While all the choices were appropriate, having a local standard approach will be helpful. Patients who had multiple organisms in their throat swab took longer to be afebrile.ReferenceBalfour-Lynn IM, et al. BTS guidelines for the management of pleural infection in children. Thorax 2005;60(Suppl I):i1–i21. doi: 10.1136/thx.2004.030676

• Publisher: BMJ Publishing Group LTD
• Subject: Amoxicillin / Antibiotics / Cefotaxime / Cefuroxime / Chest / Children / Clindamycin / Empyema / Immunization / Medical records / Microbiology / Patients / Pediatrics / Pleural fluid / Rhinovirus / Streptococcus / Streptococcus infections / Streptococcus pneumoniae / Thorax / U-Plasminogen activator