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Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia

An Australian Single-center, Retrospective Cohort 2011 to 2018

Haggie, Stuart MBBS*,†; Fitzgerald, Dominic A. MBBS, PhD*,†; Pandit, Chetan MBBS, MPhil*,†; Selvadurai, Hiran MBBS, PhD*,†; Robinson, Paul MbChB, PhD*,†; Gunasekera, Hasantha MBBS, PhD; Britton, Philip MBBS, PhD†,‡

The Pediatric Infectious Disease Journal: December 2019 - Volume 38 - Issue 12 - p e320–e325
doi: 10.1097/INF.0000000000002474
Original Studies
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Background: The impact of universal 13-valent pneumococcal conjugate vaccine immunization on pediatric empyema rates and pathogens in Australia is not known. We aimed to describe empyema epidemiology, clinical characteristics and treatment during an 8-year period.

Methods: A retrospective study between 2011 and 2018 of empyema cases admitted to a large pediatric referral hospital, for management with either pleural drainage and fibrinolytics or surgical intervention.

Results: There were 195 cases in 8 years. Empyema incidence and ICU admission rates significantly increased during the study with a peak incidence of 7.1/1000 medical admissions in 2016 (χ2 for trend of incidence 37.8, P < 0.001 and for ICU admissions 15.3, P < 0.001). S. pneumoniae was the most common pathogen (75/195, 39%) with serotype 3 the most detected (27/75: 27%). S. pyogenes compared with S. pneumoniae had significantly fewer days of fever before admission (3.9 vs. 6.4, mean difference 2.4, 95% CI: 0.84–4.08, P = 0.003) and higher proportion requiring direct ICU admission (6/75; 8% vs. 7/15; 47%, P < 0.001). Compared with S. pneumoniae, cases with no pathogen detected by culture or PCR had fewer days of fever post intervention (4.4 vs. 7.4 days, mean difference 2.7 days, P = 0.002). S. aureus occurred more commonly in infants (10/25; 40% vs. 1/75; 1%, P < 0.001) and children of indigenous background (5/25; 20% vs. 1/75; 1%, P < 0.001) compared with S. pneumoniae.

Conclusions: We report increasing rates of pediatric empyema with higher proportions requiring ICU treatment. The most common pathogens detected were S. pneumoniae, S. aureus and S. pyogenes. Despite high 13-valent pneumococcal conjugate vaccine coverage, serotype 3 was the most common S. pneumoniae serotype identified.

From the *Department of Respiratory Medicine, the Children’s Hospital at Westmead, Sydney, New South Wales, Australia

Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia

Department of Infectious Diseases, the Children’s Hospital at Westmead, Sydney, New South Wales, Australia.

Accepted for publication August 29, 2019.

The authors have no funding or conflicts of interest to disclose.

Address for Correspondence: Stuart Haggie, MBBS, Department of Respiratory Medicine, the Children’s Hospital Westmead, Sydney, NSW, Australia, 2145. E-mail: stuart.haggie@health.nsw.gov.au.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.