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Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study

1
Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
2
Children’s Research Center, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
3
Department of Pediatric Surgery, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
4
Division of Radiology, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
5
Emergency Department, University Children’s Hospital Zurich, CH–8032 Zurich, Switzerland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(5), 698; https://doi.org/10.3390/jcm8050698
Received: 15 April 2019 / Revised: 1 May 2019 / Accepted: 8 May 2019 / Published: 16 May 2019
(This article belongs to the Special Issue Diagnosis and Treatment of Pneumonia)
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Abstract

Parapneumonic effusion or pleural empyema (PPE/PE) is a frequent complication of community-acquired pneumonia (CAP) in children. Different management approaches exist for this condition. We evaluated a 14-day treatment with amoxicillin (AMX) with/without clavulanic acid (AMC) confirmed or modified by microbiological findings from pleural tap. Children ≤16 years of age with radiologically diagnosed PPE/PE and initial diagnostic pleural tap were included at University Children’s Hospital Zurich from 2001–2015. AMX/AMC was given for 14 days and rationalized according to microbiological pleural tap results. Clinical and radiological follow-up was scheduled until six months or full recovery. In 114 of 147 (78%) children with PPE/PE a pathogen was identified by culture, polymerase chain reaction (PCR), and/or antigen testing. Streptococcus pneumoniae was detected in 90 (79%), S. pyogenes in 13 (11%), and Staphylococcus aureus in seven cases (6%), all but two cultured pathogens (96%) were sensitive to AMX/AMC. One-hundred two of 147 (69%) patients received treatment with AMX/AMC for 14 days. They recovered more rapidly than patients with a different management (p = 0.026). Of 139 children with follow-up, 134 (96%) patients fully recovered. In conclusion, 14-day AMX/AMC treatment confirmed and rarely modified by microbiological findings from pleural tap resulted in full recovery in >95% of children with PPE/PE.
Keywords: antibiotics; community-acquired pneumonia; chest tube; drainage; fibrinolysis; parapneumonic effusion; pleural draining catheter; pleural tap; Streptococcus pneumoniae; thoracocentesis; thoracotomy; video-assisted thoracic surgery antibiotics; community-acquired pneumonia; chest tube; drainage; fibrinolysis; parapneumonic effusion; pleural draining catheter; pleural tap; Streptococcus pneumoniae; thoracocentesis; thoracotomy; video-assisted thoracic surgery
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Sauteur, P.M.M.; Burkhard, A.; Moehrlen, U.; Relly, C.; Kellenberger, C.; Ruoss, K.; Berger, C. Pleural Tap-Guided Antimicrobial Treatment for Pneumonia with Parapneumonic Effusion or Pleural Empyema in Children: A Single-Center Cohort Study. J. Clin. Med. 2019, 8, 698.

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