M.Sc. STUDY 2004

Management of Postpneumonic Empyema in Children: a 10-year Experience
Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, The University of Nottingham

M.Sc. Awarded in 2004

Management of Postpneumonic Empyema in Children: a 10-year Experience

My Master of Science thesis, titled "Management of Postpneumonic Empyema in Children: a 10-year Experience," investigated the treatment of empyema, a collection of pus in the chest cavity, in children. This research was conducted at the Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, at The University of Nottingham under the supervision of Dr. Harish Vyas (Consultant Paediatric Intensivist) and awarded in 2004.

Empyema is a serious complication of childhood pneumonia. While the overall incidence has declined in recent decades, some studies suggest a recent increase. This rise could be due to several factors, including delayed treatment initiation, inadequate antibiotic use, or changes in the types of bacteria causing the infection.

My thesis aimed to address two key questions:

Is medical or surgical treatment more effective for managing empyema in children?
Has the epidemiology of empyema in children changed in recent years?

By examining data from a ten-year period at a regional referral center, I sought to gain valuable insights into the best course of treatment for this condition and to understand potential changes in its prevalence and causative organisms.

Research Objectives

The management of thoracic empyema in children remains a topic of debate. This study aimed to determine whether medical treatment offered a clear advantage over surgical intervention in treating this condition.

Research Methods

We conducted a retrospective analysis of clinical data collected from children under 15 years old who were admitted or referred to our centre for post-pneumonic empyema between April 1, 1995, and January 31, 2005. Patients were categorised into two groups:

Medical Treatment Group (MTG): This group included children who initially received medical treatment, even those who ultimately required surgery due to unsuccessful medical management.
Surgical Treatment Group (STG): This group comprised patients who underwent surgery as the primary treatment approach.

Key Findings

The study identified 58 patients with a median age of 4 years who presented with empyema. Common symptoms included fever (96.5%), shortness of breath (dyspnoea) (81.2%), and cough (79.2%). Positive cultures were obtained from pleural fluid or blood in only 34% of the cases, with Streptococcus pneumoniae being the most prevalent organism (55%).

Medical Treatment Group (MTG):
- 10 patients (21%) responded successfully to medical treatment alone.
- 38 patients (79%) required surgery due to a lack of response to medical management.
- The average hospital stay for the MTG was significantly longer (16.6 days) compared to the STG (9.1 days).
- The average duration of intravenous antibiotics was also longer in the MTG (14.6 days) compared to the STG (9.1 days).
Surgical Treatment Group (STG):
- 6 patients (60%) showed complete recovery following surgery.
- 4 patients (40%) developed complications after surgery.

Microbiology:

Streptococcus pneumoniae remained the leading cause of childhood empyema.

Conclusions

This study demonstrates that:

Streptococcus pneumoniae is a major cause of empyema in children.
Surgical intervention offers a clear benefit in cases where medical treatment fails.
A prospective study involving multiple hospitals is required to definitively determine the optimal treatment approach for childhood empyema, comparing medical and surgical strategies.

This research provides valuable insights into the management of postpneumonic empyema in children. It highlights the importance of further research to establish the most effective treatment strategies for this condition.

I believe this research contributes valuable information to the ongoing discussion about the optimal management of empyema in children.

If you are interested in learning more about this topic or have any questions, please do not hesitate to contact me.

Qualification Details: M.Sc. Thesis

TITLE: Management of Postpneumonic Empyema in Children: a 10-year Experience

AUTHOR: MUAYAD A. M. FAILY (M.B.Ch.B)

ISSN:

AWARDING BODY: Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, The University of Nottingham

CURRENT INSTITUTION: The University of Duhok

DATE AWARDED: 2004

Full Text Link: [PLEASE CLICK TO VIEW THE FULL TEXT OF MY M.Sc.]

SUPERVISOR: DR. HARISH VYAS (Consultant paediatric Intensivist)

SPONSOR: The University of Nottingham

QUALIFICATION NAME: Degree of Master of Science in Clinical Microbiology

QUALIFICATION LEVEL: M.Sc.

LANGUAGE OF THE THESIS: English

REPOSITORY LINK: Forthcoming

Citation to this work:

Merza, M.A. (2004). Management of Postpneumonic Empyema in Children: A 10-Year Experience. M.Sc. Dissertation. Division of Microbiology and Infectious Diseases, School of Molecular Medical Sciences, The University of Nottingham.

Abstract:

Objectives: Management of thoracic empyema in children remains controversial. We wished to ascertain whether medical treatment was superior to surgical treatment in the management of this condition.

Methods: Clinical data were collected retrospectively for children (< 15 years old) admitted or referred (1st April 1995 to 31st January 2005) with post-pneumonic empyema. Patients were divided into a medical treatment group (MTG), including children who failed medical treatment and

required surgical intervention, and a sole surgically treated group (STG).

Results: 58 case patients were identified (median age 4 years) with empyema. Symptoms included fever (96.5%), dyspnoea (81.2%) and cough (79.2%). Pleural or blood cultures were positive in 34% of patients. The most common organism was Streptococcus pneumoniae (55%). In the MTG; 10 patients (21%) responded successfully to treatment and 38 (79%) cases failed to respond and therefore underwent surgery. The length of hospital stay was 16.6 ± 0.8 days (MTG) and 9.1 ± 0.6 days (STG) (P< 0.0001). The duration of intravenous antibiotics' intake was 14.6 ± 0.6 days (MTG) and 9.1 ± 0.4 Days (STG) (P< 0.0001). Of the MTG patients, 10 patients (22%) were successfully treated and 22 patients (48%) failed to respond to medical treatment. Of the STG 6 patients (60%) showed complete recovery and 4 patients (40%) developed complications.

Conclusions: Streptococcus pneumoniae is still a leading cause of childhood empyema. Further, surgical treatment is likely to be beneficial when medical management has failed. A true understanding of the role of medical versus surgical treatment in childhood empyema requires a prospective study inclusive of all local hospitals.

Keywords:

Thoracic empyema, Streptococcus pneumoniae, medical treatment, surgical treatment, childhood empyema

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