title: Paediatric empyema in New Zealand: a tale of two cities.
abstract: OBJECTIVE
  We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate.
  
  
  METHODS
  Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively.
  
  
  RESULTS
  Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis.
  
  
  CONCLUSIONS
  Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.
authors.forename: Cameron
authors.initials: C
authors.lastname: Burton
authors.forename: Tony
authors.initials: T
authors.lastname: Walls
authors.forename: Neil
authors.initials: N
authors.lastname: Price
authors.forename: Tamsin
authors.initials: T
authors.lastname: Glasgow
authors.forename: Cameron
authors.initials: C
authors.lastname: Walker
authors.forename: Spencer
authors.initials: S
authors.lastname: Beasley
authors.affiliation: Senior Lecturer, Department of Paediatrics, University of Auckland Paediatric Infectious Diseases Consultant, Starship Children's Health, ADHB Postal Address: Level 5 offices, Starship Children's Health, ADHB, Park Road, Grafton, Auckland, New Zealand. e.best@auckland.ac.nz.
authors.forename: Emma
authors.initials: E
authors.lastname: Best
mesh_terms: D000293:Adolescent; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D002439:Cefotaxime / Q000494:pharmacology / Q000627:therapeutic use; D002444:Cefuroxime / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D016724:Empyema, Pleural / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005436:Floxacillin / Q000494:pharmacology / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008826:Microbial Sensitivity Tests; D009520:New Zealand / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012621:Seasons; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin; D019980:Amoxicillin-Potassium Clavulanate Combination; D002439:Cefotaxime; D002444:Cefuroxime