Community-acquired pleuropneumonia in children: Bacteriological and therapeutic challenges

##plugins.themes.academic_pro.article.sidebar##

Published Sep 6, 2016
Download
pdf
Vol. 94 No. 4 (2016): Issue Apr 2016

##plugins.themes.academic_pro.article.main##

samia Hamouda
Karima Chraiet
Fatma Khalsi
Imen Bel Hadj
Ines Brini
Hanen Smaoui
Sihem Barsaoui
Azza Samoud
Saida Ben Becher
Najla Ben Jaballah
Amel Kechrid
Faten Tinsa
Khadija Boussetta

Abstract

Abstract 
Background: Community-acquired pleuropneumonia (CPP) is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality.
Aim: To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy.
Methods: Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients’ medical files. Statistical analysis was made by Epi-Info 6.
Results: One hundred and sixty four patients were registered. The mean age was 32 months (15 days - 14.5 years). The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever (93.9%), cough (56.7%) and dyspnea (48.1%). The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination (p=10-6 ). The bacteriological confirmation was attained in 44.5% of cases with the predominance of Staphylococcus aureus (59%) followed by Streptococcus pneumoniae (26%). The S. aureus occurred basically in most young infants (p=0.04) and was responsible for the most severe cases (p=0.01). The CPP management included heterogeneous intravenous antibiotics associated with a pleural drainage in 40% of cases. The quarter of our patients were transferred to an intensive care unit. Six patients died.
Conclusion: The bacteriological confirmation is difficult. Pleural aspiration is the key tool. S. aureus is the first microorganism followed by S. pneumoniae. A therapeutic strategy is proposed based on large spectrum intravenous antibiotics. The pleural drainage indication is limited.

Keywords:

Pleural empyema, Child, Pleural aspiration, Thoracic drainage, Therapeutic strategy.

##plugins.themes.academic_pro.article.details##

References

  1. Desrumaux A, François P, Pascal C, Cans C, Croizé J, Gout JP, et al. Épidémiologie et caractéristiques cliniques des complications suppuratives des pneumonies de l'enfant. Arch Pediatr 2007;14:1298-303.
  2. Thumerelle C, Santos C, Morillon S, Bott L, Pouessel G, Deschildre A. Facteurs de risque de survenue des pleuropneumopathies bactériennes en pédiatrie. Arch Pediatr 2005;12:827-9.
  3. Chavanet P. Pneumococcus infections: Is the burden still as heavy? Med Mal Infect 2012;42:149-53.
  4. Weil-Olivier C, Levy C, Marguet C, Sardet A, De La Rocque F, Lécuyer A, et al. Enquête rétrospective multicentrique sur les pleuropneumopathies infectieuses de l'enfant en France. Arch Pediatr 2005;12:823-6.
  5. Gasior AC, Marty Knott E, Sharp SW, Ostlie DJ, Holcomb GW 3rd, St Peter SD. Experience with an evidence-based protocol using fibrinolysis as first line treatment for empyema in children. J Pediatr Surg 2013;48:1312-5.
  6. Byington CL, Spencer LY, Johnson TA, Pavia AT, Allen D, Mason EO, et al. An epidemiological investigation of a sustained high rate of pediatric parapneumonic empyema: risk factors and microbiological associations. Clin Infect Dis 2002;34:434-40.
  7. Byington CL, Korgenski K, Daly J, Ampofo K, Pavia A, Mason EO. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J 2006;25:250-4.
  8. Gupta R, Crowley S. Increasing paediatric empyema admissions. Thorax 2006;61:179-80.
  9. François P, Desrumaux A, Cans C, Pin I, Pavese P, Labarère J. Prevalence and risk factors of suppurative complications in children with pneumonia. Acta Paediatr 2010;99:861-6.
  10. Elemraid MA,Thomas MF, Blain AP, Rushton SP, Spencer DA, Gennery AR, et al. Risk Factors for the Development of Pleural Empyema in Children. Pediatr Pneumol 2014;23041:1-6.
  11. Laupland KB, Davies HD, Low DE, Schwartz B, Green K, McGeer A, et al. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Pediatrics 2000;105:1-7.
  12. Dass R, Deka NM, Barman H, Duwarah SG, Khyriem AB, Saikia MK, et al. Empyema Thoracis: Analysis of 150 Cases from a Tertiary Care Centre in North East India. Indian J Pediatr 2011;78:1371-7.
  13. Spencer DA, Cliff D. The changing epidemiology of parapneumonic empyema in children. Pediatr Child Health 2008;18:513-8.
  14. Grace Devota Gomez G, Gonzales L, Ong-Lim A. Clinical profile and outcome of children with parapneumonic effusion. PIDSP J 2012;13:15-28.
  15. Tan TQ, Edward O, Mason JR, Wald ER, Barson WJ, Schutze GE, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae. Pediatrics 2002;110:1-6.
  16. Balfour-Lynn IM, Abrahamson E, Cohen G, et al. BTS guidelines for the management of pleural infection in children. Thorax 2005;6:1-21.
  17. Niemi E, Korppi M. Parapneumonic empyema in children before the era of pneumococcal vaccination. Acta Paediatr 2011;100:1230-3.
  18. Cirino LM, Gomes FM, Batista BN. The etiology of extensive pleural effusions with troublesome clinical course among children. Sao Paulo Med J. 2004;122:269-72.
  19. Rosenstengel A. Pleural infection-current diagnosis and management. J Thorac Dis 2012;4:186-93.
  20. Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. Guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011;66:1-23.
  21. Soares P, Barreira J, Pissarra S, Nunes T, Azevedo I, Vaz L. Pediatric parapneumonic pleural effusions: Experience in a university central hospital. Rev Port Pneumol 2009;15:241-59.
  22. Le Monnier A, Carbonelle E, Zahar JR, et al. Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids. Clin Infect Dis 2006;42:1135-40.
  23. Menezes-Martins LF, Menezes-Martins JJ, Michaelsen VS, Aguiar BB, Ermel T, Machado DC. Diagnosis of parapneumonic pleural effusion by polymerase chain reaction in children. J Pediatr Surg 2005;40:1106-10.
  24. Vu-Thien H. Pleuro-pneumopathies: épidémiologie bactérienne et résistances aux antibiotiques. Arch Pediatr 2008;15:81-3.
  25. Eastham KM, Freeman R, Kearns AM, et al. Clinical features, aetiology and outcome of empyema in children in the north east of England. Thorax 2004;59:522-5.
  26. Rachdi M, Boutiba-Ben Boubaker I, Mahjoubi-Rhimi F, Smaoui H, Hammami A, Kéchrid A, et al. Serotype distribution and antimicrobial resistance patterns of Streptococcus pneumoniae isolated in Tunisia. J Med Microbiol 2011;60:391-3.
  27. Charfi F, Smaoui H, A. Kechrid A. Non-susceptibility trends and serotype coverage by conjugate pneumococcal vaccines in a Tunisian paediatric population: A 10-year study. Vaccine 2012;30:18-24.
  28. Wells RG, Havens PL. Intrapleural fibrinolysis for parapneumonic effusion and empyema in children. Radiology 2003;228:370-8.
  29. Yao CT, Wu JM, Lui CC, Wu MH, Chuang HY, Wang JN. Treatment of complicated parapneumonic pleural effusion with intrapleural streptokinase in children. Chest 2004;125:566-71.
  30. Gaudelus J, Dubos F, Dommergues MA, Vu-Thien H, Bingen E, Cohen R, et al. antibiothérapie des pleuropneumopathies de l'enfant : quelles leçons tirer des études cliniques publiées et propositions thérapeutiques. Arch Pediatr 2008;15:84-92.
  31. Brémont F, Morelle K, Guilloux S. Traitement chirurgical des pleuropneumopathies bactériennes du nourrisson et de l'enfant : les indications discutables. Arch Pediatr 2005;12:832-4.
  32. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53:617-30.
  33. Carter E, Waldhausen J, Zhang W, Hoffman L, Redding G. Management of Children With Empyema:Pleural Drainage Is Not Always Necessary. Pediatr Pulmonol 2010;45:475-80.
  34. Cohen G, Hjordtal V, Ricci M, Jaffe A, Watlis C, Dinwiddie R, et al. Primary thoracoscopic treatment of empyema in children. J Thorac Cardiovasc Surg 2003;125: 79-84.
  35. Cohen E, Weinstein M, Fisman DN. Cost-effectiveness of competing strategies for the treatment of pediatric empyema. Pediatrics 2008;121:1250-7.