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Forster J, Piazza G, Goettler D, Tanzberger EL, Kenntner S, Schoen C, Streng A, Liese JG. Empiric Antibiotic Therapy in 1402 Children With Parapneumonic Effusion/Pleural Empyema in Germany: A Long-term Surveillance Study. Pediatr Infect Dis J 2024:00006454-990000000-00852. [PMID: 38713819 DOI: 10.1097/inf.0000000000004359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with pediatric parapneumonic effusion/pleural empyema (PPE/PE). METHODS A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ2 test/Fisher exact test, Mann-Whitney U test and linear regression analysis adjusting for patient age where appropriate. RESULTS Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children. CONCLUSION This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
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Affiliation(s)
- Johannes Forster
- From the Institute for Hygiene and Microbiology, University of Würzburg
| | - Giuseppina Piazza
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | | | - Simone Kenntner
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Christoph Schoen
- From the Institute for Hygiene and Microbiology, University of Würzburg
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
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Kuru M, Altinok T. Empyema in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S29-S36. [PMID: 38584781 PMCID: PMC10995679 DOI: 10.5606/tgkdc.dergisi.2024.25759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 04/09/2024]
Abstract
Empyema is the infection of the fluid in the pleural space due to different causes. The most common cause of empyema in children is parapneumonic effusion. Although its frequency has decreased significantly with the use of antibiotics, it is still a significant cause of morbidity and mortality worldwide. The main aim in the treatment of empyema is to drain the pleural cavity to provide reexpansion of the compressed lung, to treat the parenchymal infection with appropriate antibiotic therapy, and to prevent complications that may develop in the acute and chronic periods. Treatment options for this disease vary depending on the stage of the disease. Treatment success in childhood empyema detected at an early stage is high. The diagnosis and treatment of empyema in children differs from adults. Due to rapid tissue regeneration in childhood, healing can occur without the need for aggressive treatment options.
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Affiliation(s)
- Murat Kuru
- Department of Thoracic Surgery, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye
| | - Tamer Altinok
- Department of Thoracic Surgery, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye
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Fernandez Elviro C, Longcroft-Harris B, Allin E, Leache L, Woo K, Bone JN, Pawliuk C, Tarabishi J, Carwana M, Wright M, Nama N. Conservative and Surgical Modalities in the Management of Pediatric Parapneumonic Effusion and Empyema: A Living Systematic Review and Network Meta-Analysis. Chest 2023; 164:1125-1138. [PMID: 37463660 DOI: 10.1016/j.chest.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/08/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The optimal treatment for community-acquired childhood pneumonia complicated by empyema remains unclear. RESEARCH QUESTION In children with parapneumonic effusion or empyema, do hospital length of stay and other key clinical outcomes differ according to the treatment modality used? STUDY DESIGN AND METHODS A living systematic review of randomized controlled trials (RCTs) was conducted by searching the Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, Ovid MEDLINE, and Web of Science Core Collection databases. Eligible RCTs included patients aged < 18 years and compared two of the following treatment modalities: antibiotics alone, chest tube insertion with or without fibrinolytics, video-assisted thoracoscopic surgery (VATS), and decortication via thoracotomy. A network meta-analysis was performed to evaluate treatment effects on hospital length of stay (LOS), the primary outcome. RESULTS Eleven trials including a total of 590 patients were selected for the network meta-analysis. Compared with a chest tube alone, a chest tube with fibrinolytics, thoracotomy, and VATS were all associated with shorter LOS, with a mean difference of 5.05 days (95% CI, 2.46-7.64), 6.33 days (95% CI, 3.17-9.50), and 5.86 days (95% CI, 3.38-8.35), respectively. No substantial differences in LOS were observed between the latter three interventions. None of the 11 RCTs compared antibiotics alone vs other types of treatment. Most trials reported peri-procedural complications and the need for reintervention, but the descriptions differed significantly between trials, preventing meta-analysis. In trials reporting health care-associated costs, fibrinolytics had cost advantages compared with VATS. Short- and long-term morbidity and mortality were very low, regardless of the treatment modality. INTERPRETATION The results of this network meta-analysis showed that a chest tube alone was associated with a longer LOS compared with other treatment modalities. The lower cost associated with a chest tube plus fibrinolytics warrants consideration when choosing between treatment options, given similar LOS and clinical outcomes compared with the other modalities.
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Affiliation(s)
- Clara Fernandez Elviro
- Division of Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada; Department Woman-Mother-Child, Service of Paediatrics, Paediatric Pulmonology and Cystic Fibrosis Unit, University Hospital of Lausanne and Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | | | - Emily Allin
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Leire Leache
- Unit of Innovation and Organization, Navarre Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Kellan Woo
- Vancouver-Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey N Bone
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Colleen Pawliuk
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jalal Tarabishi
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Matthew Carwana
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Division of General Pediatrics, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Marie Wright
- Division of Respiratory Medicine, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nassr Nama
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA.
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Böckle CE, Blaser J, Schukfeh N, Zeidler J, Ure BM, Dingemann J. Analysis of Pulmonary Surgery in Children and Adolescents in Germany: Who Is doing What? Eur J Pediatr Surg 2022; 32:327-333. [PMID: 34148226 DOI: 10.1055/s-0041-1731030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION In Germany, pediatric surgery is organized in a decentralized manner. A nationwide clinical registry does not exist. The aim of this research is to analyze the current status of pulmonary surgery in the country in respect of children and adolescents. MATERIALS AND METHODS Claims data have been extracted from two health insurance databases representing 34% of the German population. Operative diagnoses and procedures, as well as patients' characteristics, were recorded from 2016 to 2019. RESULTS The incidence of the four index diagnoses investigated matched the current literature in three of four entities. The main indications <8 years were congenital lung malformations (61%) and spontaneous pneumothorax at age 8 to 17 years (77%). Furthermore, 1,668 pediatric pulmonary procedures (0-17 years) were identified (668 pulmonary resections). Two age peaks were identified: 13% of patients were operated on before 1 year old and 50% of patients were between 15 and 17 years old. Video-assisted-thoracoscopic-surgery (VATS) for pulmonary resections was applied in 62% of cases. 96% of pulmonary resections in patients <1 year and 70% of pulmonary resections in children between 1 and 14 years were performed by pediatric surgeons. Of patients between 15 and 17 years old, only 14% were operated on in pediatric surgery. The estimated average pulmonary resection caseload was 3.2 cases per year and per institution for pediatric surgery and 1.5 for adult surgery. CONCLUSION Indications for pulmonary surgery in children arise from rare diagnoses. In total, 66% of lung resections are performed in patients <1 year and >14 years. The majority of lung resections are performed as VATS. Patients ≤14 years are predominantly operated on by pediatric surgeons. The accessibility of pediatric pulmonary surgery is acceptable, but there is a low caseload per center.
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Affiliation(s)
- Carla E Böckle
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jochen Blaser
- Techniker Krankenkasse (Health Insurance)-Representative Office of Lower Saxony, Hannover, Lower Saxony, Germany
| | - Nagoud Schukfeh
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jan Zeidler
- Leibniz University Hannover-Center for Health Economics Research Hannover (CHERH), Hannover, Lower Saxony, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
| | - Jens Dingemann
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Lower Saxony, Germany
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Yang G, Wen Y, Chen T, Xu C, Yuan M, Li Y. Comparison of pediatric empyema secondary to tuberculosis or non-tuberculosis community-acquired pneumonia in those who underwent surgery in high TB burden areas. Pediatr Pulmonol 2021; 56:3321-3331. [PMID: 34289260 DOI: 10.1002/ppul.25591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Tuberculous empyema (TE) in children is common in high-TB burden and medical resource-limited areas. However, studies that evaluate the characteristics of TE in children are sparse. This study aimed to analyze the clinical features of pediatric TE receiving surgical intervention. METHODS We performed a retrospective study of children with empyema secondary to community-acquired pneumonia who underwent surgery in our institution. The clinical characteristics were compared between TE and empyema secondary non-tuberculosis infection (non-tuberculosis empyema, NTE). RESULTS One hundred patients were included (27 with TE and 73 with NTE). Stage 3 empyema occupied 81.5% and 45.2% of TE and NTE in this study. The TE children had older age, longer duration of illness, and milder symptoms. Pleural fluid culture was positive for Mycobacterium tuberculosis in 7.4% of patients with TE. Lymph node enlargement, lymph node calcification, and pleural nodules presented in TE with high specificity (93.2%, 98.6%, and 98.5%) but low sensitivity (33.3%, 14.8%, and 29.6%) on CT scan. Thoracoscopy surgery was performed in 14 (51.9%) in TE and 39 (53.4%) in NTE. Postoperative chest-tube indwelling time was longer (7.85 ± 5.00 vs. 4.89 ± 1.81 days, p < .001), and more patients had incomplete lung expansion after 3 months in TE. CONCLUSION Tuberculosis infection should be screened in management of children with empyema in high-TB burden areas. Pediatric TE usually presented at older age and with milder respiratory symptoms. Pleural biopsy during surgery is often necessary to confirm the cause of infection. Thoracotomy is still required in some pediatric TE or NTE with delayed treatment in medical resource-limited area.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yang Wen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ting Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chang Xu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Miao Yuan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Rix-Trott K, Byrnes CA, Gilchrist CA, Matsas R, Walls T, Voss L, Mahon C, Dickson NP, Reed P, Best EJ. Surveillance of pediatric parapneumonic effusion/empyema in New Zealand. Pediatr Pulmonol 2021; 56:2949-2957. [PMID: 34232567 DOI: 10.1002/ppul.25564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 11/07/2022]
Abstract
AIM The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand. METHODS A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires. RESULTS Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Māori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%). CONCLUSIONS New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Māori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.
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Affiliation(s)
- Katherine Rix-Trott
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Catherine A Byrnes
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Richard Matsas
- KidzFirst Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch, New Zealand.,Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Lesley Voss
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Caroline Mahon
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Nigel P Dickson
- New Zealand Paediatric Surveillance Unit, Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Reed
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Emma J Best
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Nwagboso CI, Ekeng BE, Etiuma AU, Ochang EA, Eze JN, Echieh CP. Microbiological profile and antibiotic resistance pattern of empyema thoracis in Calabar, Nigeria. Trop Doct 2021; 51:523-526. [PMID: 34459297 DOI: 10.1177/00494755211032844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Targeted empirical antibiotic therapy based on local microbiology and antibiotic resistance patterns is essential for the treatment of empyema thoracis. Our retrospective review of 105 pleural empyema culture and sensitivity reports aimed at determining the causative microorganisms and their antimicrobial resistance pattern. Of 105 pleural aspirate samples, 46 (43.8%) were positive on culture. Gram-negative organisms (n = 43) were the predominant isolates, the commonest of which was Klebsiella pneumoniae. It was concluded that empyema thoracis is predominantly caused by Gram-negative organisms in our locality. This should guide protocols on the initiation of empirical therapy.
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Affiliation(s)
- C I Nwagboso
- Cardiothoracic Surgeon, Division of Cardiothoracic & Vascular Surgery, Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - B E Ekeng
- Clinical Microbiologist, Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - A U Etiuma
- Cardiothoracic Surgeon, Division of Cardiothoracic & Vascular Surgery, Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E A Ochang
- Clinical Microbiologist, Department of Medical Microbiology and Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - J N Eze
- Cardiothoracic Surgeon, Division of Cardiothoracic & Vascular Surgery, Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
| | - C P Echieh
- Cardiothoracic Surgeon, Division of Cardiothoracic & Vascular Surgery, Department of Surgery, University of Calabar/University of Calabar Teaching Hospital, Calabar, Nigeria
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Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
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Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
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Kanitra JJ, Thampy CA, Cullen ML. A decade's experience of pediatric lung abscess and empyema at a community hospital. Pediatr Pulmonol 2021; 56:1245-1251. [PMID: 33386780 DOI: 10.1002/ppul.25254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Discussions on the diagnostic and management of acquired pediatric lung pathology are usually published by large tertiary children's hospitals. It is likely that much of this pathology is actually seen and managed in nonacademic practices. METHODS A 10-year retrospective review of patients under 18-years of age, treated for lung abscesses or empyema was performed. RESULTS Nineteen empyema and four lung abscesses were included. Presenting symptoms, workup, and management are reviewed. A unique subset (n = 4) of atypical pulmonary pathology is described. A 14-year-old with a vaping history and a lung abscess misdiagnosed as an empyema. A 15-year-old with primary pulmonary Hodgkin's lymphoma presenting as a lung abscess and empyema. A 5-year-old with an empyema complicated by a bronchopleural fistula and a 21-year-old with autism and an acquired lung cyst. CONCLUSION Our dilemmas, experiences, and strategies in managing complex lung disease are generalized to community-based practice.
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Affiliation(s)
- John J Kanitra
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Chelsea A Thampy
- Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Marc L Cullen
- Division of Pediatric Surgery, Department of Surgery, Ascension St. John Hospital, Detroit, Michigan, USA
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Xiao J, He W. The immunomodulatory effects of vitamin D drops in children with recurrent respiratory tract infections. Am J Transl Res 2021; 13:1750-1756. [PMID: 33841698 PMCID: PMC8014391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the effects of vitamin D drops on immune function in children with recurrent respiratory tract infections (RRTI). METHODS The clinical data of 119 children with RRTI in our hospital were retrospectively retrieved, and they were divided into group A (n=59, receiving routine treatment) and group B (n=60, receiving vitamin D drops) based on their treatment modality. The clinical efficacy, symptom disappearance time, immune function index, insulin-like growth factor (IGF-1), 25-hydroxyvitamin D3 [25-(OH)D3], serum y-interferon (INF-y), and the number of episodes of respiratory tract infections were compared between the two groups. RESULTS The total effective rate of treatment in group B was 96.67%, which was significantly higher than 71.19% in group A (P<0.05). Children in group B had shorter time to disappearance of lung rales, cough, and fever than group A (P<0.05). Group B had higher IgA, IgG, and IgM levels, higher CD4+, CD3+ levels and lower CD8+ levels as well as higher IGF-1, 25-(OH)D3, INF-y levels, and fewer respiratory infections after treatment than group A (P<0.05). CONCLUSION Vitamin D drops are effective in the treatment of children with RRTI, which is beneficial to the improvement of clinical symptoms and immune function.
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Affiliation(s)
- Jianqiu Xiao
- Department of Pediatrics, The First People's Hospital of Fuyang Hangzhou Hangzhou 311400, Zhejiang Province, China
| | - Wei He
- Department of Pediatrics, The First People's Hospital of Fuyang Hangzhou Hangzhou 311400, Zhejiang Province, China
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Moral L, Toral T, Clavijo A, Caballero M, Canals F, Forniés MJ, Moral J, Revert R, Lucas R, Huertas AM, González MC, García-Avilés B, Belda M, Marco N. Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage. Front Pediatr 2021; 9:621943. [PMID: 34368022 PMCID: PMC8335639 DOI: 10.3389/fped.2021.621943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD). Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018. Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721). Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.
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Affiliation(s)
- Luis Moral
- Pediatric Respiratory and Allergy Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Teresa Toral
- Pediatric Respiratory and Allergy Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Agustín Clavijo
- Department of Pediatrics, Marina Baixa Hospital, Villajoyosa, Spain
| | - María Caballero
- Department of Pediatrics, Vinalopó University Hospital, Elche, Spain
| | - Francisco Canals
- Department of Pediatrics, Elche University General Hospital, Elche, Spain
| | - María José Forniés
- Department of Pediatrics, Virgen de la Salud University General Hospital, Elda, Spain
| | - Jorge Moral
- Faculty of Medicine, Miguel Hernández University, Sant Joan d'Alacant, Spain
| | - Raquel Revert
- Department of Pediatrics, Alicante University General Hospital, Alicante, Spain
| | - Raquel Lucas
- Department of Pediatrics, Marina Salud Hospital, Denia, Spain
| | - Ana María Huertas
- Department of Pediatrics, Vinalopó University Hospital, Elche, Spain
| | | | - Belén García-Avilés
- Department of Pediatrics, Sant Joan d'Alacant University Clinical Hospital, Sant Joan d'Alacant, Spain
| | - Mónica Belda
- Department of Pediatrics, Virgen de los Lirios Hospital, Alcoy, Spain
| | - Nuria Marco
- Department of Pediatrics, Vega Baja Hospital, Orihuela, Spain
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Barglik R, Grabowski A, Korlacki W, Pasierbek M, Modrzyk A. Pleural empyema in children - benefits of primary thoracoscopic treatment. Wideochir Inne Tech Maloinwazyjne 2021; 16:264-72. [PMID: 33786143 DOI: 10.5114/wiitm.2020.97443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Pleural empyema is the condition of the pleural cavity when initially sterile pleural effusion has become infected. In the majority of cases, it is of parapneumonic origin. Parapneumonic effusions and pleural empyemata usually continuously progress in severity. The American Thoracic Society divides them into three stages: exudative, fibrinopurulent and organizing. The therapy depends on the stage. Aim To assess whether thoracoscopy should be considered better than conservative treatment and to assess the feasibility of the thoracoscopic approach to the 3rd phase of pleural empyema. Material and methods The clinical course of 115 patients treated from 1996 to 2017 was analyzed. 45 patients operated on thoracoscopically after the failure of conventional treatment were compared with 70 patients treated by primary thoracoscopic drainage and decortication. Results The results of the study demonstrated that patients treated primarily by thoracoscopy had a shortened length of hospital stay (16.6 vs. 19.3 days), reduced drainage time (7.9 vs. 9.8 days), and shorter time of general therapy (31.8 vs. 38.0 days). They required fibrinolysis less frequently (12.8 vs. 26.7% of patients) and had reduced risk of reoperation (10 vs. 15.6% of cases). Operation time in the 3rd stage was only 15 min longer. The difference in length of hospital stay was only 0.8 days in favor of less severe cases. Conclusions The thoracoscopic approach is safely feasible in the 3rd stage of pleural empyema and should be considered as the preferred approach. Furthermore, the post-operative stay and general course of the disease are milder whenever surgery would not be delayed by prolonged conservative treatment attempts.
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Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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14
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Nandan D, Agarwal S, Bidhuri N, Shrivastava K, Nanda P, Lata S. Role of Intrapleural Urokinase in Empyema Thoracis. Indian J Pediatr 2019; 86:1099-1104. [PMID: 31628638 DOI: 10.1007/s12098-019-03060-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/06/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of fibrinolytic therapy in pediatric empyema in relation to duration of hospital stay, need for surgical intervention and survival to discharge. METHODS Retrospective analysis of case records of children <16 y of age admitted in a tertiary care hospital during January 2013 - December 2017 with diagnosis as empyema thoracis was done. Clinico-laboratory characteristics and the primary and secondary outcomes between the group which received intrapleural urokinase (IPU) and the group which did not (non IPU), were compared. RESULTS Of the 84 cases, 40 children received IPU. Mean duration of hospital stay in IPU group (17.51 + 4.57 d) was significantly less than non IPU group (24.32 + 10.18 d, CI -10.19 to -3.64, p < 0.001), so was the duration of intercostal drain (ICD) insertion (9.08 + 3.12 d - IPU group vs. 11.20 + 3.95 d - non IPU group, CI -3.68 to -0.50, p < 0.01). No statistically significant difference was found between the groups with regard to need for surgical intervention [IPU - 4 (10%), non IPU - 9 (20.4%), p = 0.23]. There was no mortality or adverse reaction to urokinase in either group. CONCLUSIONS IPU holds promising results in terms of reduction of hospital stay and duration of ICD insertion. It may be the initial choice of treatment in septated empyema where surgical options are not easily available or cost-effective especially in resource limited settings.
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Affiliation(s)
- Devki Nandan
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | - Sheetal Agarwal
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India.
| | - Neha Bidhuri
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | | | - Pamali Nanda
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
| | - Sandhya Lata
- Department of Pediatrics, PGIMER and Dr. RML Hospital, Delhi, India
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15
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Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice. Pediatrics 2019; 144:peds.2019-1402. [PMID: 31481415 DOI: 10.1542/peds.2019-1402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
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Affiliation(s)
- Thomas W Conlon
- Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Departments of Anesthesiology and Critical Care Medicine and
| | - Yogen Singh
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Hopital Antoine Béclère, University Hospitals of South Paris, AP-HP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Inserm U999, Université Paris-Saclay, Paris, France; and
| | - David O Kessler
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Erik R Su
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Aaron E Chen
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - María V Fraga
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Liese J, Schoen C, van der Linden M, Lehmann L, Goettler D, Keller S, Maier A, Segerer F, Rose M, Streng A. Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study. Clin Microbiol Infect 2019; 25:857-64. [DOI: 10.1016/j.cmi.2018.10.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/20/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022]
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17
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Meyer Sauteur PM, Burkhard A, Moehrlen U, Relly C, Kellenberger C, Ruoss K, Berger C. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J Clin Med 2019; 8:E698. [PMID: 31100958 DOI: 10.3390/jcm8050698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023] Open
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.
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18
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Díaz-Conradi A, Hernández S, García-García JJ, Muñoz-Almagro C, Moraga-Llop F, Ciruela P, Izquierdo C, Campins M, de Sevilla MF, González-Peris S, Uriona S, Martínez-Osorio J, Solé-Ribalta A, Codina G, Esteva C, Planes AM, Soldevila N, Salleras L, Domínguez A. Complicated pneumococcal pneumonia with pleural effusion or empyema in the 13-valent pneumococcal conjugate vaccine era. Pediatr Pulmonol 2019; 54:517-524. [PMID: 30784235 DOI: 10.1002/ppul.24279] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/09/2019] [Indexed: 11/06/2022]
Abstract
AIM The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015. RESULTS We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10-5 persons/year in cases with PE or empyema and 2.09 cases × 10-5 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054). CONCLUSIONS A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant reduction in PCV13 serotypes, especially serotype 1, coinciding with increased PCV13 coverage.
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Affiliation(s)
| | - Sergi Hernández
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain.,Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Pilar Ciruela
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain.,CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Conchita Izquierdo
- Agència de Salut Publica de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Malalties Prevenibles amb vacunes, Institut de Recerca Sant Joan de Déu, Esplugues, Barcelona, Spain.,Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Nuria Soldevila
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Luis Salleras
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Angela Domínguez
- CIBER de Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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19
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Ren CL, Muston HN, Yilmaz O, Noah TL. Pediatric Pulmonology year in review 2017: Part 3. Pediatr Pulmonol 2018; 53:1152-1158. [PMID: 29806188 DOI: 10.1002/ppul.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022]
Abstract
Pediatric Pulmonology publishes original research, reviews, and case reports related to a wide range of children's respiratory disorders. We here summarize the past year's publications in our major topic areas, in the context of selected literature in these areas from other journals relevant to our discipline. This review (Part 3 of a 5-part series) covers selected articles on asthma, physiology/lung function testing, and respiratory infections.
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Affiliation(s)
- Clement L Ren
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Heather N Muston
- Riley Children's Hospital, Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Knebel R, Fraga JC, Amantea SL, Isolan PBS. Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion. J Pediatr (Rio J) 2018; 94:140-145. [PMID: 28837796 DOI: 10.1016/j.jped.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/11/2017] [Accepted: 03/06/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of videothoracoscopic surgery in the treatment of complicated parapneumonic pleural effusion and to determine whether there is a difference in the videothoracoscopic surgery outcome before or after the chest tube drainage. METHODS The medical records of 79 children (mean age 35 months) undergoing videothoracoscopic surgery from January 2000 to December 2011 were retrospectively reviewed. The same treatment algorithm was used in the management of all patients. Patients were divided into two groups: in group 1, videothoracoscopic surgery was performed as the initial procedure; in group 2, videothoracoscopic surgery was performed after previous chest tube drainage. RESULTS Videothoracoscopic surgery was effective in 73 children (92.4%); the other six (7.6%) needed another procedure. Sixty patients (75.9%) were submitted directly to videothoracoscopic surgery (group 1) and 19 (24%) primarily underwent chest tube drainage (group 2). Primary videothoracoscopic surgery was associated with a decrease of hospital stay (p=0.05), time to resolution (p=0.024), and time with a chest tube (p<0.001). However, there was no difference between the groups regarding the time until fever resolution, time with a chest tube, and the hospital stay after videothoracoscopic surgery. No differences were observed between groups regarding the need for further surgery and the presence of complications. CONCLUSIONS Videothoracoscopic surgery is a highly effective procedure for treating children with complicated parapneumonic pleural effusion. When videothoracoscopic surgery is indicated in the presence of loculations (stage II or fibrinopurulent), no difference were observed in time of clinical improvement and hospital stay among the patients with or without chest tube drainage before videothoracoscopic surgery.
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Affiliation(s)
- Rogerio Knebel
- Universidade Federal de Santa Maria (UFSM), Hospital Universitário de Santa Maria (HUSM), Santa Maria, RS, Brazil.
| | - Jose Carlos Fraga
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Sergio Luis Amantea
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Hospital Santo Antônio de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paola Brolin Santis Isolan
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Departamento de Cirurgia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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21
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Knebel R, Fraga JC, Amantéa SL, Isolan PBS. Videothoracoscopic surgery before and after chest tube drainage for children with complicated parapneumonic effusion. Jornal de Pediatria (Versão em Português) 2018. [DOI: 10.1016/j.jpedp.2017.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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22
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Lewis MR, Micic TA, Doull IJM, Evans A. Real-time ultrasound-guided pigtail catheter chest drain for complicated parapneumonic effusion and empyema in children - 16-year, single-centre experience of radiologically placed drains. Pediatr Radiol 2018; 48:1410-1416. [PMID: 29951836 PMCID: PMC6105150 DOI: 10.1007/s00247-018-4171-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chest tube drainage with fibrinolytics is a cost-effective treatment option for parapneumonic effusion and empyema in children. Although the additional use of ultrasound (US) guidance is recommended, this is rarely performed in real time to direct drain insertion. OBJECTIVE To evaluate the effectiveness and safety of real-time US-guided, radiologically placed chest drains at a tertiary university hospital. MATERIALS AND METHODS This was a retrospective review over a 16-year period of all children with parapneumonic effusion or empyema undergoing percutaneous US-guided drainage at our centre. RESULTS Three hundred and three drains were placed in 285 patients. Treatment was successful in 93% of patients after a single drain (98.2% success with 2 or 3 drains). Five children had peri-insertion complications, but none was significant. The success rate improved with experience. Although five patients required surgical intervention, all children treated since 2012 were successfully treated with single-tube drainage only and none has required surgery. CONCLUSION Our technique for inserting small-bore (≤8.5 F) catheter drains under US guidance is effective and appears to be a safe procedure for first-line management of complicated parapneumonic effusion and empyema.
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Affiliation(s)
- Megan R. Lewis
- Department of Postgraduate Medical and Dental Education at Cardiff University, Heath Park Way, Cardiff, UK CF14 4YU
| | - Thomas A. Micic
- Department of Paediatric Radiology, Children’s Hospital for Wales, Heath Park, Cardiff, UK CF14 4XW
| | - Iolo J. M. Doull
- Department of Paediatric Respiratory Medicine, Children’s Hospital for Wales, Cardiff, UK CF14 4XW
| | - Alison Evans
- Department of Paediatric Radiology, Children’s Hospital for Wales, Heath Park, Cardiff, UK CF14 4XW
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Course CW, Hanks R, Doull I. Question 1 What is the best treatment option for empyema requiring drainage in children? Arch Dis Child 2017; 102:588-590. [PMID: 28468869 DOI: 10.1136/archdischild-2017-312938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/03/2022]
Affiliation(s)
| | - Ruth Hanks
- Department of Paediatric Respiratory Medicine, Children's Hospital for Wales, Cardiff, UK
| | - Iolo Doull
- Department of Paediatric Respiratory Medicine, Noah's Ark Children's Hospital for Wales, Cardiff, UK
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