Pneumococcal pleural empyemas in children.
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.
Hardie
W
W
Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, Ohio 45229-3039, USA.
Bokulic
R
R
Garcia
V F
VF
Reising
S F
SF
Christie
C D
CD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D004352:Drug Resistance, Microbial; D016724:Empyema, Pleural / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D012621:Seasons; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents