Grisaru-Soen Galia, Eisenstadt Michal, Paret Gideon, Schwartz David, Keller Nathan, Nagar Hagit, Reif Shimon
Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Pediatr Emerg Care. 2013 Apr;29(4):425-9. doi: 10.1097/PEC.0b013e318289e810.
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.
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.
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.
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.
小儿脓胸的发病率正在上升，仍然是儿童发病的一个原因。我们的目的是确定两家以色列儿科医疗中心小儿脓胸的危险因素、临床特征、病原体分布及转归。
这是一项回顾性病例对照研究，研究对象为在肺炎球菌结合疫苗（PCV）时代之前（2000 - 2009年）因社区获得性肺炎（CAP）住院的2个月至18岁儿童。从病历和计算机微生物学数据库中回顾人口统计学数据、出现的症状、体格检查结果、影像学检查、实验室结果、住院过程、药物治疗及外科干预措施。
191名儿童中，47名（24.9%）患有肺炎旁胸腔积液，144名（75.4%）无胸腔积液。与无胸腔积液的患儿相比，有胸腔积液的患儿症状和病程明显更严重。最常见的病原体是肺炎链球菌。最常见的肺炎球菌血清型是5型，86%分离出的肺炎链球菌对青霉素敏感。有胸腔积液的患儿最常见的表现为持续发热、呼吸困难（51%）和胸痛（17%）。45名有胸腔积液的患儿（98%）需要胸腔置管、纤维蛋白溶解或电视辅助胸腔镜手术（VATS）下的胸膜剥脱术。接受VATS治疗的有胸腔积液的患儿与接受传统治疗的患儿住院时间相似。
患有和未患有胸腔积液的CAP患儿中最常见的病原体均为肺炎链球菌。与单纯CAP患儿相比，有胸腔积液的患儿发病情况明显更严重。根据我们的经验，与传统治疗相比，VATS显然并未缩短住院时间。免疫接种可能会影响小儿脓胸的发病率，应进行前瞻性研究。
