title: An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations.
abstract: We investigated the increasing incidence of pediatric empyema during the 1990s at Primary Children's Medical Center in Salt Lake City. Of 540 children hospitalized with community-acquired bacterial pneumonia (CAP) who were discharged from 1 July 1993 through 1 July 1999, 153 (28.3%) had empyema. The annual population incidence of empyema increased during the study period from 1 to 5 cases per 100,000 population aged <19 years. Streptococcus pneumoniae was identified as the most common cause of CAP with or without empyema; serotype 1 accounted for 50% of the cases of pneumococcal empyema. Patients with empyema were more likely to be >3 years old, to have > or =7 days of fever, to have varicella, and to have received antibiotics and ibuprofen before admission to the hospital, compared with patients without empyema (P<.0001 for each factor). The increasing incidence of empyema was associated with infection due to S. pneumoniae serotype 1, outpatient treatment with certain antibiotics, ibuprofen use, and varicella.
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT, 84132, USA. cbyington@med.utah.edu
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Byington
authors.forename: LaShonda Y
authors.initials: LY
authors.lastname: Spencer
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Johnson
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Daniel
authors.initials: D
authors.lastname: Allen
authors.forename: Edward O
authors.initials: EO
authors.lastname: Mason
authors.forename: Sheldon
authors.initials: S
authors.lastname: Kaplan
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.forename: Judy A
authors.initials: JA
authors.lastname: Daly
authors.forename: John C
authors.initials: JC
authors.lastname: Christenson
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D004653:Empyema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae