title: Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management.
abstract: OBJECTIVE
  Pediatric empyema is increasing in incidence and continues to be a source of morbidity in children. Our objective was to determine the risk factors, clinical characteristics, distribution of the pathogens, and outcome of pediatric empyema in 2 Israeli pediatric medical centers.
  
  
  METHODS
  This was a retrospective case-control study on children aged 2 months to 18 years hospitalized with community-acquired pneumonia (CAP) in the pre-Prevnar era (2000-2009). Demographic data, presenting symptoms, physical examination findings, imaging studies, laboratory results, hospital course, medical treatment, and surgical interventions were reviewed from medical records and computerized microbiology databases.
  
  
  RESULTS
  One hundred ninety-one children comprised of 47 (24.9%) with parapneumonic empyema and 144(75.4%) without empyema. The symptoms and course of the children with empyema were substantially worse compared with patients without empyema. The most prevalent pathogen was Streptococcus pneumonia. The most common pneumococcal serotype was serotype 5, and 86% of the recovered S. pneumoniae were susceptible to penicillin. Children with empyema most commonly presented with prolonged fever, dyspnea (51%), and chest pain (17%). Forty-five children with empyema (98%) required a chest tube, fibrinolysis, or decortication with video-assisted thoracoscopy (VATS). Hospitalization stay was similar for children with empyema who underwent VATS and those who were treated conventionally.
  
  
  CONCLUSIONS
  The most prevalent pathogen in children with CAP with and without empyema is S. pneumoniae. Children with empyema experience significantly more morbidity than did patients with CAP alone. In our experience, VATS apparently does not shorten the duration of hospitalization compared with conventional treatment. Immunization may affect the incidence of pediatric empyema and should be studied prospectively.
authors.affiliation: Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. galiag@post.tau.ac.il
authors.forename: Galia
authors.initials: G
authors.lastname: Grisaru-Soen
authors.forename: Michal
authors.initials: M
authors.lastname: Eisenstadt
authors.forename: Gideon
authors.initials: G
authors.lastname: Paret
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.forename: Hagit
authors.initials: H
authors.lastname: Nagar
authors.forename: Shimon
authors.initials: S
authors.lastname: Reif
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016724:Empyema, Pleural / Q000382:microbiology* / Q000601:surgery / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000187:drug effects*
chemical_list: D022242:Pneumococcal Vaccines