1200. Pediatric Parapneumonic Empyema in Israel: Risk Factors, Clinical Characteristics and Microbiologic Associations
Session: Poster Abstract Session: Other Bacterial Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Pediatric empyema is increasing in incidence and continues to be a source of morbidity in children. We determined the risk factors, clinical charactaristics, distribution of the pathogens and outcome of pediatric empyema  in 2 pediatric centers in Israel.

Methods: We performed a retrospective case-control study among children age 2 months-18 years who were hospitalized with community acquired pneumonia (CAP), in 2 pediatric tertiary care centers in Israel, between January 2000 to June 2009. Demographic data, presenting symptoms, physical examination findings, imaging studies, laboratory results, hospital course, medical treatment and surgical interventions were reviewed from the medical records and computerized microbiology database. 

Results: 191children were included, 47 (24.9%) with parapneumonic empyema and 144 (75.4%) with simple CAP. A similar number of cases were seen throughout the years, until 2008, in which a significantly higher rate of empyema was detected. Children with empyema had significantly longer duration of fever, were more likely to have dyspnea and chest pain at admission and had higher levels of CRP. The empyema group had a significantly larger number of positive blood cultures.  The most prevalent pathogen was S. pneumonia . The most common pneumococcal serotype was serotype 5. 86% of the S. pneumonia recovered were penicillin susceptible. Children in the empyema group had a substantially longer hospital stay, and exhibited more significant morbidity. The majorities (45 children) were treated in the intensive care units and many required interventions including chest tube, fibrinolysis and decortication with VATS (video-assisted thoracoscopy). No significant difference was demonstrated in the duration of hospitalization between children with empyema who went through VATS and those who were treated conventionally. 

Conclusion: The incidence of pediatric empyema is increasing. Children with empyema most commonly present with prolong fever, dyspnea and chest pain. The most prevalent pathogen is S. pneumonia . Patients with empyema experienced significantly more morbidity then patients with CAP alone. Immunization may affect the incidence of empyema in children and should be studied prospectively.


Subject Category: P. Pediatric and perinatal infections

Galia Grisaru-Soen, Dr., Pediatrics, Dana Children’s Hospital Sourasky Medical Center, Tel-Aviv, Israel, Gideon Paret, Prof., Pediatrics, Safra Children’s Hospital, Ramat-Gan, Israel, Shimon Reif, Prof., Dana Children’s Hospital Sourasky Medical Center, Tel-Aviv, Israel, David Schwartz, MD, Sourasky Medical Center, Tel-Aviv, Israel and Michal Eisenstadt, Dr., Safra Children’s Hospital, Ramat-Gan, Israel

Disclosures:

G. Grisaru-Soen, None

G. Paret, None

S. Reif, None

D. Schwartz, None

M. Eisenstadt, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.