Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study.
BACKGROUND
Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada.


METHODS
Health records for children<18 years admitted from 1/1/00-31/12/03 were searched for ICD-9 code 510 or ICD-10 code J869 (Empyema). Empyema was defined as at least one of: thoracentesis with microbial growth from pleural fluid, or no pleural fluid growth but compatible chemistry or cell count, or radiologist diagnosis, or diagnosis at surgery. Patients with empyemas secondary to chest trauma, thoracic surgery or esophageal rupture were excluded. Data was retrieved using a standard form with a data dictionary.


RESULTS
251 children met inclusion criteria; 51.4% were male. Most children were previously healthy and those<or=5 years of age comprised 57% of the cases. The median length of hospitalization was 9 days. Admissions occurred in all months but peaked in winter. Oxygen supplementation was required in 77% of children, 75% had chest tube placement and 33% were admitted to an intensive care unit. While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedures (thoracentesis, placement of chest tubes) was observed between centers. The most common organism found in normally sterile samples (blood, pleural fluid, lung biopsy) was Streptococcus pneumoniae.


CONCLUSIONS
Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.
Langley
Joanne M
JM
Department of Pediatrics, Dalhousie University, Halifax, Canada. jmlangle@dal.ca
Kellner
James D
JD
Solomon
Nataly
N
Robinson
Joan L
JL
Le Saux
Nicole
N
McDonald
Jane
J
Ulloa-Gutierrez
Rolando
R
Tan
Ben
B
Allen
Upton
U
Dobson
Simon
S
Joudrey
Heather
H
D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology*; D017281:Cost of Illness; D019468:Disease Management; D004653:Empyema / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D032541:Mass Vaccination; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000209:etiology
D022242:Pneumococcal Vaccines