Empyema Thoracis in Children: Experience from a tertiary care hospital in Pune, India

Abstract

Background: Empyema thoracis in children has remained a therapeutic problem despite advances in treatment modalities in developing countries. Objective: To study demographic and clinical profile, laboratory characteristics, causative organisms, treatment modalities, complications and outcome of children admitted with empyema thoracis. Materials and Methods: A cross sectional study was conducted over three years from February 2007 to February 2010 in a tertiary care hospital. The study group included patients of 0-12 years age group hospitalised with diagnosis of empyema thoracis. Demographic details and clinical profile was analysed retrospectively from hospital records. Results: 60 patients in the age group of 0-12 years were included in the study. Among total cases, (50%) were infants and children up to 3 years of age. Incidence was more in summer 42 (70%) than in monsoon and winter. Fifty three percent children were undernourished. Fever, cough, and breathlessness were the commonest symptoms (96.66%, 83.33% and 73.33% respectively). Gram stain showed organisms in 50% cases while culture was positive in 58.33% cases. In this study, pyogenic aetiology was seen in 95% cases while tubercular in 5%. Staphylococcus aureus was the most common organism found on pleural fluid gram stain and culture. Fifteen percent children were treated conservatively, where as 85% required ICD (Inter costal drain) insertion along with antibiotics. Out of these patients requiring ICD, 25% required decortication and 10% required video assisted thoracoscopic surgery (VATS). Pneumothorax was the most common complication 8 (13.33% cases). 15 (25%) children, who required ICD for more than 15 days, had high LDH level above 3000 IU/L. Conclusion: Staphylococcus aureus was the most common organism found on pleural fluid culture.