title: Empyema thoracis: a 10-year comparative review of hospitalised children from south Asia.
abstract: OBJECTIVE
  To study the clinical and microbial profile of childhood empyema in South Asia and to identify the changes over the past three decades.
  
  
  METHODS
  A total of 265 children (aged 1 month to 12 years) with empyema admitted to the Advanced Pediatric Center, PGIMER, Chandigarh, India in 1989-98, were reviewed retrospectively.
  
  
  CONCLUSIONS
  One third of children were under 5. Culture positivity had decreased significantly (48% v 75%) over the years. Staphylococcus aureus continues to be the commonest (77%) aetiological agent; clustering was seen during hot and humid months (46%). Culture positive Streptococcus pneumoniae cases also decreased (9% v 27%); all were seen during the winter and spring season. Gram negative rods grew in more patients (11% v 7%). Community acquired methicillin resistant S aureus (MRSA) was isolated in three patients. Most children (93%) were treated with parenteral cloxacillin and an aminoglycoside. Tube drainage (TD) was used in 92% of fibropurulent cases, and was successful in 79%. Of 48 patients with failed TD, 12 needed decortication; limited thoracotomy was sufficient in the remaining 36. Surgery was mainly required by children with persistent pleural sepsis after 10 days of TD. Delaying surgery until 14 days had a significantly higher potential of requiring decortication. Early change to oral antibiotics (after 1-2 weeks of parenteral therapy) reduced the hospital stay significantly (17+7 v 23+7 days) without compromising long term outcome. Twenty two patients presenting late in the chronic stage underwent decortication at admission.
authors: Department of Pediatrics, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. baranwal1970@yahoo.com
authors: A K
authors: AK
authors: Baranwal
authors: M
authors: M
authors: Singh
authors: R K
authors: RK
authors: Marwaha
authors: L
authors: L
authors: Kumar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003906:Developing Countries; D004322:Drainage / Q000379:methods; D016724:Empyema, Pleural / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D013203:Staphylococcal Infections / Q000150:complications; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents