PNEUMOCOCCAL PLEURAL EMPYEMAS IN CHILDREN

Empyema rarely complicates pneumonia. In a 361-bed regional pediatric hospital, 50 pleural empyemas were identified from 1988 through 1994; 17 (34%) occurred in the last 12 months of this period, for which the incidence was 3.3 per 100,000 of the population aged less than or equa l to 18 years (P < .05, chi(2) test). A significant seasonal prevalenc e was observed: 50% of cases occurred in the winter (P < .001, chi(2) test). In contrast with the findings of previous studies, in which emp yemas predominantly occurred in infants, the median age of our patient s was 7 years; underlying illnesses were present in only 10%, and all had community-acquired disease, Eighty-two percent had chest tubes ins erted, 56% required a thoracotomy with pleural decortication, and 2% h ad a lobectomy. There were no deaths. Streptococcus pneumoniae was iso lated in 40% of the cases; specimens in 44% of the cases were sterile. None of the empyemas were associated with Staphylococcus aureus or Ha emophilus influenzae type b, and only one was caused by group A strept ococcus. Among 13 S. pneumoniae isolates, the rate of resistance to pe nicillin was 15%; to erythromycin, 15%; to chloramphenicol, 31%; and t o cefotaxime, 23%. The penicillin-resistance rate among blood and cere brospinal fluid pneumococcal isolates was 17% during 1993-1994. Drug-r esistant S. pneumoniae is now a recognized cause of pleural empyemas i n children.