MANAGEMENT OF THORACIC EMPYEMA IN CHILDHOOD - A STUDY OF 160 CASES

A total of 160 cases of thoracic empyema admitted to our clinic betwee n September 1988 and March 1994 have been analyzed retrospectively. Th ere were 83 males and 77 females whose ages ranged from 25 days to 13 years. Cough (82%), fever (81%), and dyspnea (70%) were the most commo n presenting symptoms followed by chest pain, abdominal pain, and cyan osis. The preadmission history was often long (average 14 days). Follo wing admission antibiotic therapy was initiated by parenteral administ ration of sulbactam-ampicillin? amikacin or netilmicin, and ornidazole or clindamycin and modified with vancomycin or piperacillin on the ba sis of culture and sensitivity reports. Fifty-four of 156 aerobic and 2 of 28 anaerobic cultures were positive. Staphylococcus aureus was th e most common (57%) micro-organism isolated followed by Pseudomonas ae roginosa and Streptococcus pneumoniae. In addition, 5 of 11 Haemophilu s influenzae latex-agglutination tests were positive. Two patients wit h pneumatocele formation received antibiotics as the only therapy, In the remaining patients, in addition to antibiotics treatment modalitie s included tube drainage (n = 111), decortication (n = 39), decorticat ion with lobectomy or segmentectomy (n = 6), and pneumonectomy (n = 2) . The overall mortality was 5%. Our results show that appropriate anti biotics and tube drainage provide effective control of childhood thora cic empyema, although in patients with serious respiratory distress an d poor response to tube drainage, operative intervention is required.