Clinical, diagnostic and therapeutic characteristics of pleural empyema in children hospitalized during years 2000-2004 at National Hospital Cayetano Heredia

Abstract

Objective: To describe the clinical, diagnostic and therapeutic characteristics of pediatric patients with diagnosis of pleural empyema hospitalized at National Hospital Cayetano Heredia from january 2000 to december 2004. Material and methods: Clinical histories were reviewed being the investigated variables age, sex, study of pleural liquid, cultures, treatment, complications and time of hospitalization. For the statistical analysis it was used x2 of Pearson. Results: There were 22 patients with diagnosis of empyema. The ratio male/female was of 9/2; the median of age was 3 years (1 to 10 years), the median of days of hospitalization was 11. 5 days (3 to 28 days). In 8 patients (36.3%) there were complications (bullae: 7, pneumothorax: 3. bronchopleural fistula: 1. pulmonary abscess: 1). The time of hospitalization was longer associated to the surgical treatment (p<0.05). The germ was identified in 12 cases (54.5%) (Blood culture: 2, pleural liquid Culture: 10. Agglutination in pleural liquid: 1) being Streptococcus pneumoniae, the most frequent (58.3%) followed by Haemophilus influenzae (25%) and Staphylococcus aureus (16.6%). In 1 patient with surgical treatment acid alcohol resistant bacillus positive was isolated in pleural biopsy. Conclusions: Empyema is the most common in male patient younger than 5 years (77%) being the germ more commonly isolated Streptococcus pneumoniae followed by Haemophilus influenzae and Staphylococcus aureus. There was coexistence of empyema and acid alcohol resistant bacillus positive in pleural biopsy of one patient with surgical treatment. Medical treatment failured in 31.8% of patients and requiered surgical treatment. There were no predictive factors at the entrance or in pleural liquid when comparing medical treatment (15 cases) versus surgical treatment (7 cases); nor differences in complications.