Complicated parapneumonic effusion and empyema in children.
OBJECTIVE
Parapneumonic effusion and empyema are recognized complications of bacterial pneumonia. Optimal management in children, especially the duration of parenteral antibiotics and the role of surgery, is controversial. This study analyzed the clinical characteristics, management, outcome, and bacterial etiology of 59 patients with complicated parapneumonic effusion and empyema treated at a single medical center in Kaohsiung from January 1995 to March 2004.


METHODS
The diagnosis of complicated parapneumonic effusion was based on the specific characteristics of pleural fluid, computed tomography or ultrasound findings, or direct visualization of loculations during the surgical procedure.


RESULTS
Causative agents were culture-confirmed in 42% of the cases. Streptococcus pneumoniae was the leading pathogen in this series (20% of cases). None of the S. pneumoniae isolates were susceptible to penicillin. Mycoplasma pneumoniae accounted for 19% of cases based on immunoglobulin M assay.


CONCLUSIONS
An initial combination therapy regimen consisting of cefotaxime or ceftriaxone plus macrolide provided reasonable activity against 80% of the pathogens isolated in this series. This study also revealed that prolonged parenteral antibiotic treatment resulted in longer length of hospital stay.
Shen
Yea-Huei
YH
Division of Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung , Taiwan.
Hwang
Kao-Pin
KP
Niu
Chen-Kuang
CK
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D016724:Empyema, Pleural / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D007231:Infant, Newborn; D018942:Macrolides / Q000627:therapeutic use; D008297:Male; D009177:Mycoplasma pneumoniae / Q000276:immunology; D010403:Penicillin Resistance; D010406:Penicillins / Q000494:pharmacology; D010996:Pleural Effusion / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D018410:Pneumonia, Bacterial / Q000150:complications*; D011019:Pneumonia, Mycoplasma / Q000150:complications; D012189:Retrospective Studies; D012621:Seasons; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M; D018942:Macrolides; D010406:Penicillins; D002443:Ceftriaxone