title: [Complicated pleural infection: Analysis of 2 consecutive cohorts managed with a different policy].
abstract: BACKGROUND
  The treatment of complicated pleural infection (CPI) is controversial. Clinical guidelines recommend drainage, but with the lowest grade of evidence. Recent reports have observed good outcomes with antibiotics alone. We retrospectively compared the outcomes in two consecutive cohorts treated with different policies: the first treated according to pleural fluid charactersitics (2005-2009, interventional-prone, group 1) and the second according to clinical assessment (2010-2013, conservative-prone, group 2).
  
  
  METHODS
  The clinical records of all children treated for CPI in our hospital between 2005 and 2013 were thoroughly reviewed. Primary outcomes were the proportion of children drained and the length of hospital stay (LHS).
  
  
  RESULTS
  One hundred and nine patients (64 group 1 and 45 group 2) were analyzed. A chest tube was placed in 83% of patients in group 1 and 47% in group 2 (P<0.001). The mean LHS was 11.4 days for patients in group 1 and 12.3 for patients in group 2 (P=0.45); no differences were observed in other outcomes.
  
  
  CONCLUSIONS
  Our results add to few recent observations reporting good outcomes in many children treated with antibiotics alone and challenge the need to drain most children with CPI. Clinical trials are now needed to identify when a drainage procedure would be useful.
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España. Electronic address: lmoralg@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Moral
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: C
authors.initials: C
authors.lastname: Loeda
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: F
authors.initials: F
authors.lastname: Gómez
authors.affiliation: Servicio de Farmacología Clínica, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Pena
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: M
authors.initials: M
authors.lastname: Martínez
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Cerdán
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: L
authors.initials: L
authors.lastname: Lillo
authors.affiliation: Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, España.
authors.forename: T
authors.initials: T
authors.lastname: Toral
mesh_terms: D015505:Chest Tubes; D002648:Child; D004322:Drainage; D006801:Humans; D008171:Lung Diseases / Q000628:therapy*; D010996:Pleural Effusion / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Antibiotics; Antibióticos; Chest tube; Drenaje pleural; Empiema pleural; Infección pleural; Pleural drainage; Pleural empyema; Pleural infection; Tubo torácico