Methods: Since October-2005 until September-2015, active surveillance for pleural empyema (PE) in children < 16 years old was performed in the Tijuana, Mexico, General Hospital (TGH). Diagnosis of PE was established by Lyell criteria of a pleural effusion with a community acquired pneumonia +- bacterial isolation. For Streptococcus pneumoniae isolates serotype identification was performed using the Quellung reaction (Statens Serum Institute®, Copenhagen, Denmark). A descriptive analysis for all PPE was performed.
Results: A total of 48 PE were diagnosed. Bacterial identification was possible in 35 (73%) cases. Among these, 26 (74.28%) were caused by S. pneumoniae. Median age for PPE was of 3.91 years (4 months -15 years), pleural decortication was performed in 10 patients (38.5%), and one patient died. Before PCV13 implementation (a period of 77 months), the total number of PPE were of 21 (3.27 cases per year), with serotypes 3, 19A and 6A/C accounting for 64.3% of cases since PCV13 introduction. Following PCV13 implementation (43 months period), PPE dropped to 5 cases (1.4 cases per year), with isolation of serotypes 6A/C, 7B,15, 3 and 24F (one each). Appearance of non-PPE started to appear since 2010 with two cases, but have increased since implementation of PCV13 (seven cases). Non-pneumococcal isolates have been Staphylococcus aureus (3), Streptococcus pyogenes (2), and Streptococcus salivarus, Group Milleri Streptococcus, Klebsiella oxytoca and Pseudomonas aeruginosa(one each).
Conclusion: 1. Following PCV13 universal vaccination, all PPE cases have decreased, with a trend on decrease on serotypes 6A/C, 3 and 19A. 2. This study shows an impact of PCV13 on PPE, however, early appearance of non-pneumococcal bacteriae causing PE is present. 3. Continuous active surveillance for PE is mandatory.
R. M. Rivas-Landeros, None
M. L. Volker-Soberanes, None
J. A. Alvelais-Palacios, None