title: Factors associated with empyema in children with community acquired pneumonia.
abstract: OBJECTIVE
  Empyema is a potential complication of community acquired pneumonia but factors predicting this complication are lacking.
  
  
  METHODS
  A retrospective study of all previously healthy pediatric patients admitted between January 2007 and July 2009 with CAP. Patients with non-lobar pneumonia, RSV bronchiolitis, underlying chronic disease, or hospital-acquired pneumonia were excluded. Preadmission, clinical characteristics on admission, and outcome were compared between patients with and without empyema. Management strategies in patients with empyema were also compared.
  
  
  RESULTS
  Overall 356 patients were included. Median age was 3.8 ± 3.54 years and 60.7% were males. A total of 43 patients (12%) were diagnosed with empyema. The development of empyema was independently associated, on multivariate analysis, with older age, female gender and antibiotic therapy prior to admission, and with dyspnea, thrombocytopenia and involvement of more than one lobe on chest radiograph on admission. Patients who developed empyema had a longer and more complicated course. Hypoxemia on admission was significantly less frequent in patients with empyema who were treated with antibiotic therapy alone, compared to those treated with chest tube or video-assisted thoracoscopic surgery.
  
  
  CONCLUSIONS
  Early identification of dyspnea and thrombocytopenia in patients with community acquired pneumonia could alert physicians on the potential development of empyema. Antibiotic therapy alone may be sufficient in patients with empyema who are mildly hypoxemic on admission.
authors: Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler Faculty of Medicine, Tel‑Aviv University, Tel‑Aviv, Israel - abukishki@gmail.com.
authors: I
authors: I
authors: Abu-Kishk
authors: E
authors: E
authors: Zohar
authors: M
authors: M
authors: Berkovitch
authors: E
authors: E
authors: Kozer
authors: E
authors: E
authors: Seguier-Lipszyc
authors: B
authors: B
authors: Klin
authors: A
authors: A
authors: Elizur
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology; D004653:Empyema / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents